Screening Adolescent Females for Chlamydia Infection

To the Editor: Although I support the recommendation of Dr Burstein and colleagues¹ for frequent screening of adolescents for chlamydia infection, the authors neglected to address an issue fundamental to the validity of their findings. At the first visit, patients testing positive for Chlamydia trachomatis were treated with either oral doxycycline, 100 mg twice daily for 7 days, or a single oral 1-g dose of azithromycin. Single-dose therapy delivered in the clinic is considered effective treatment, but the success of a 7-day regimen depends on patient compliance. Some of the cases identified in the study as "repeat infections" (ie, patients testing positive for chlamydia at least 30 days earlier) could have been treatment failures. Given this possibility, it was incumbent on the authors to present either a rigorous method of how they verified patient compliance with therapy or an analysis of their data by treatment modality, or both.