Evaluation of a free mail-in opt-out STI testing programme on 3-month rescreening rates in reproductive health...

The Centers for Disease Control guidelines recommend rescreening for chlamydia, gonorrhoea and trichomoniasis 3 months after treatment to detect reinfection. This intervention aimed to improve rescreening rates by removing multiple logistical and financial barriers to rescreening within our influence for the greatest possible effect.

For 1 year (2022, n=837), free (to the patient) rescreen tests were automatically mailed to all patients in 21 health centres 3 months after they were treated for chlamydia, gonorrhoea and/or trichomoniasis, unless they opted out or were rescreened sooner. Patients returned the completed mail-in self-collection kit in a prepaid envelope within 2-4 weeks. Rescreening rates were compared with a control period (2019, n=1743).

A total of 2580 rescreen opportunities (intervention=837, control=1743) were tracked for rescreening. The median age was 23, 66% were female, 80% were white and 79% tested positive for chlamydia. The intervention increased rescreening rates from 22% to 26%, which was not statistically significant after adjustment (OR 1.20, 95% CI 0.98 to 1.48, p=0.08).

A 4% increase in rescreening rates did not justify programme continuation. While rescreening has been an important public health strategy to reduce sexually transmitted infections (STIs), this programme reveals that high rates of rescreening may not be possible. Recommending rescreening and making it free, convenient and automatic is not enough. Without new ideas and approaches to tackling this public health problem, STI reinfection and resulting reproductive health complications will persist.