Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in the Netherlands; response to a text message reminder and reinfection rates: a prospective study with historical controls

CJG Kampman; FDH Koedijk; HCM Driessen-Hulshof; JLA Hautvast; IVF van den Broek

doi:10.1136/sextrans-2015-052115

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Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in the Netherlands; response to a text message reminder and reinfection rates: a prospective study with historical controls

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Re: Retesting Chlamydia trachomatis in a GUM clinic in London, UK
CJG Kampman
Published on: 29 August 2016
Retesting Chlamydia trachomatis in a GUM clinic in London, UK
Nadia Ahmed
Published on: 22 August 2016

Published on: 29 August 2016
Re: Retesting Chlamydia trachomatis in a GUM clinic in London, UK
- CJG Kampman
- Other Contributors:
  FDH Koedijk, HCM Driessen-Hulshof, JLA Hautvast and IVF van den Broek
Thank you very much for carefully reading our article and for your positive feedback. We have read your E-letter with great interest. We are pleased that our publication contributed to adjustment of your policy concerning retesting. Implementing a text message reminder and lengthening the follow up period to 3 months is likely to elevate the return rate and positivity rate. According to our research, you may even consider...
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Thank you very much for carefully reading our article and for your positive feedback. We have read your E-letter with great interest. We are pleased that our publication contributed to adjustment of your policy concerning retesting. Implementing a text message reminder and lengthening the follow up period to 3 months is likely to elevate the return rate and positivity rate. According to our research, you may even consider lengthening the follow up period to 6 months to yield even more chlamydia reinfections.
In your letter you show that you already achieve a relatively high return rate of 26.8% without sending a text message reminder. Also, in research from Burton et al, 2014, the return rate was high with 35% without sending a text message reminder. These are much higher return rates than in our control group (9.2%). In your E-letter (Ahmed et al. STI, 2016), you question whether patients in the Netherlands are advised to do a repeat test. We do have an informal guideline concerning this advice, though it is not certain that every clinic in our study group gave this advice. Therefore we cannot state that this retest-advice is consistently given, and that could have (in part) caused our relatively low return-rates in the control group. Also, you state in the E-letter that sexual health appointments in your service are available by booking in advance or on the day. It is unclear to me whether this means that an appointment for retest is already made after initial consultation or that patients who want to do a retest can come at any day. In our study, booking in advance was not done. In our STI clinics, the usual waiting time for non-emergency sexual health consultations is 2-3 weeks. This could be an additional factor in the difference between our return rate and the return rate of the UK research described.
In the Netherlands, the sexual health clinics are exploring and implementing cost-effective strategies to lower the threshold for (re- )testing on STI. As an example of how to make retesting more (cost-) effective, we like to refer to a Dutch article by Gotz, et al [1], where the retest participation was higher in the patient-group that received a testkit at their home address (46%, 50/109), compared to the group asked to visit the STI clinic for retesting without an appointment (23%, 25/107). Home-based testkits can be a good method to increase the re- attendance rate. Though some STI-clinics in the Netherlands implement this strategy for low-risk patients, it hasn't yet been implemented for the purpose of a retest. This might, however, be an interesting cost-effective way to identify chlamydia reinfections.
[1] G?tz HM, Wolfers MEG, Luijendijk A, van den Broek IVG. Retesting for genital Chlamydia trachomatis among visitors of a sexually transmitted infections clinic: randomized intervention trial of home- versus clinic- based recall. BMC Infectious Diseases 2013, 13:239
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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Published on: 22 August 2016
Retesting Chlamydia trachomatis in a GUM clinic in London, UK
- Nadia Ahmed, GU Consultant
- Other Contributors:
  Rita Browne
We read with interest the recent report by Kampman et al, 2016 [1] on the effect of text reminders on patients attending for repeat chlamydia tests and chlamydia diagnosis.
In our service, the St. Ann's Sexual Health Centre, a GUM clinic in London, UK, our routine practice was to verbally advise patients treated for chlamydia to re-attend 6-8 weeks after treatment for re-testing. Sexual health appointments are...
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We read with interest the recent report by Kampman et al, 2016 [1] on the effect of text reminders on patients attending for repeat chlamydia tests and chlamydia diagnosis.
In our service, the St. Ann's Sexual Health Centre, a GUM clinic in London, UK, our routine practice was to verbally advise patients treated for chlamydia to re-attend 6-8 weeks after treatment for re-testing. Sexual health appointments are available either by booking in advance or on the day depending on timing and capacity. We reviewed our overall practice in managing chlamydia infections against the British Association for Sexual Health and HIV (BASHH) national guidelines, but with a particular focus on repeat testing. BASHH recommend a test of cure (testing at 3-5 weeks) in certain groups (e.g. pregnant women) and repeat testing 3 months after treatment in under 25 year olds, and considered, in high risk groups. All patients with a positive chlamydia NAAT result over a two month period in 2014 were identified and their clinical care evaluated.
108 patients were identified compared to 838 analysed by Kampman et al spanning over a year as well as from ten STI clinics. Our cohort represented our local demographics; 54% female, 72.6% under the age of 25 years old, 41.6% of Black Afro-Caribbean or Black British ethnicity and 96.6% heterosexual. 39% were symptomatic compared to 32% in the Netherlands cohort.
36% (65/180) attended for a repeat test in our cohort compared to the Netherlands group where 9.2% (140/1530) returned without reminder and 30.6% (253/838) in the study group who received a text message after 6 months. The median time to attendance for a repeat test after treatment was 6 weeks (IQR (6-8) in our cohort, compared to re-testing being concentrated within 5-8 months in the study group of Kampman et al. At our centre only one patient tested positive for CT which was due to re- infection, whereas 20.4% (56/275) of the Netherlands study group had a repeat infection.
Our data reflects that of the other UK data highlighted, from Burton et al, 2014, with a re-test rate in their control group who did not receive a text message, of 35% (92/226). Although the authors state a comparison cannot be made given the higher re-test rate of the UK group compared to their control group, some inferences can be made. It is interesting that there is an increase of 26.8% in those attending for a repeat test without a text reminder in our group. Although the total number included in the Netherlands group is larger compared to ours, the former was data collated over a year at ten sites, compared to over two months at our site alone. Kampman et al do not mention whether patients were advised to have a repeat test, unlike our patients who are all informed about repeat testing after 6-8 weeks at the time of treatment. This is a simple intervention which could enhance their rate of re- attendance. Furthermore, the number of re-infections was significantly greater than our rate. This may reflect the varying denominators and/or the greater length of time before re-testing (6 months compared to 6-8 weeks after treatment), as this potentially allows for a greater time period to acquire re-infection. The higher numbers re-testing in our group may also be due to the shorter interval between treatment and re-testing.
Overall our centre met the BASHH 2015 standards in the management of chlamydia. However, we felt that a move from re-testing at 6 weeks to re- testing at 3 months in high risk groups (patients aged < 25 years and MSM) would be more cost effective as it will identify any treatment failures and potentially more re-infections.
We continue to inform patients about re-testing when they are being treated and have also introduced text reminders at 3 months. Text reminders are an acceptable, easy and cost-effective strategy to increase efficiency especially given NHS targets and cuts to public health funding.
References 1)Kampman CJG, Koedijk FDH, Driessen-Hulshof HCM, et al. Retesting young STI clinic visitors with urogenital Chlamydia trachomatis infection in the Netherlands; response to a text message reminder and reinfection rates: a prospective study with historical controls.Sex Transm Infect 2016;92:124- 9. 2) Burton J, Brook G, McSorley J, et al. The utility of short message service (SMS) texts to remind patients at higher risk of STIs and HIV to reattend for testing: a controlled before and after study. Sex Transm Infect 2014;90:11-13.?
Conflict of Interest:
None declared
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Conflict of Interest:
None declared.
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