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Journal Club: Do text message reminders help youth and young adults with Chlamydia trachomatis to improve retesting and to decrease reinfection rates?

Article reviewed

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. Published Online First: [24 Sept 2015] doi:10.1136/sextrans-2015-052115.

Purpose of the study

In the Netherlands, as in Canada, infection with Chlamydia trachomatis disproportionately affects adolescents and young adults [1,2]. A particular challenge with Chlamydia is the high rate of asymptomatic infection and re-infection in both males and females. Given the possible negative reproductive health outcomes, such as pelvic inflammatory disease (particularly with repeated episodes of infection), retesting is crucial among this age group [3-6]. 

As with Canadian guidelines, Dutch guidelines recommend retesting patients with Chlamydia infection 6 months after the initial treatment [7]. This study aimed to assess: (1) the effect of using a low cost technology, text messaging, on retesting and Chlamydia reinfection rates in young heterosexuals, compared to a historical control group, and (2) to assess factors associated with both outcomes.


The study population included heterosexual males and females, and bisexual females aged 16-23 who tested positive for urogenital Chlamydia trachomatis and who were treated with 1g of oral Azithromycin at diagnosis. It excluded men who have sex with men, and individuals with repeat positive tests or concurrent anorectal Chlamydia.

The setting was 10 publically funded sexually transmitted infection clinics, in mostly rural areas of the Netherlands. The design involved a non-randomized prospective cohort with a historical control, for which the same inclusion and exclusion criteria were used.

The intervention applied to the prospective cohort included two separate text message reminders to retest, sent at 5 ½ and 6 months after the initial Chlamydia diagnosis.

Key findings

Among the prospective cohort receiving text message reminders, there was a 30.6% response to the Chlamydia retest offer. This was much higher than the 9.2% of historical controls who retested within the same 5-8 month timeframe.

Chlamydia reinfection rates among the study group were 20%, compared to an overall prevalence of 16% among all eligible study participants during the study period. Individuals who had been notified by a partner of exposure to infection, and those with STI-related symptoms, were factors associated with reinfection in the study group.

Implications for practice

Sending a text message appears to be an effective way to remind Chlamydia-positive young heterosexuals and bisexual women to retest at 6 months post infection.

Given the limitations in study design, practitioners should look for further research on text message interventions, particularly qualitative designs that ask youth and young adults about barriers and preferences related to text message reminders. This will be especially important in young men, who retested less frequently than young woman but experienced higher rates of reinfection.

Further information

Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/26404946


  1. Soetens LC, Koedijk FDH, Vriend HG, et al. Sexually transmitted diseases, including HIV, in the Netherlands in 2012. Infectieziekten Bulletin 2013;24:291-3.
  2. BC Centre for Disease Control (2014). British Columbia Annual Summary of Reportable Diseases. Available Online [www.bccdc.ca] Accessed: 15 Nov 2015.
  3. Lamontagne DS, Baster K, Emmett L, et al. Incidence and reinfection rates of genital chlamydial infection among women aged 16-24 years attending general practice, family planning and genitourinary medicine clinics in England: a prospective cohort study by the Chlamydia Recall Advisory Group. Sex Transm Infect 2007;83:292-303.
  4. Walker J, Tabrizi SN, Fairley CK, et al. Chlamydia trachomatis incidence and reinfection among young woman – behavioural and microbiological characteristics. PLoS ONE 2012;7:e37778.
  5. Woodhall SC, Atkins JL, Soldan K, et al. Repeat genital Chlamydia trachomatis testing rates in young adults in England, 2010. Sex Transm Infect 2013;89:51-6.
  6. Haggerty CL, Gottlieb SL, Taylor BT, et al. Risk of sequelae after Chlamydia trachomatis genital infection in women. J Infect Dis 2010;201:s134-55.
  7. De Vries HJC, Van Doomum GJJ, Bax CJ, et al. Multidisciplinary protocol on sexually transmitted diseases for second line care 2012. Available Online [www.soaaids.nl] Accessed: 15 Nov 2015.