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Last reviewed: 20 Apr 2025
Last updated: 01 May 2025

Summary

Your Organisational Guidance

ebpracticenet urges you to prioritise the following organisational guidance:

Diagnose, behandeling, opvolging en doorverwijzing van infecties met Chlamydia trachomatis (CT) in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2025Diagnostic, traitement, suivi et renvoi des infections à Chlamydia trachomatis (CT) en soins primairesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2025

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • asymptomatic

Other diagnostic factors

  • cervical discharge
  • friable cervix
  • abnormal vaginal bleeding
  • penile discharge
  • vaginal discharge
  • dysuria
  • pelvic pain
  • fever/chills
  • nausea/vomiting
  • scrotal pain
  • myalgias
  • abdominal pain
  • mucopurulent rectal discharge or tenesmus
  • joint pain and swelling
  • eye irritation
  • rashes
  • inflammation

Risk factors

  • age under 25 years, sexually active
  • new sex partner or multiple sex partners
  • sexual activity with infected partner
  • condoms not used
  • history of prior STI
  • ethnicity
  • urban residence and low socio-economic status

Diagnostic investigations

1st investigations to order

  • nucleic acid amplification test (NAAT)

Investigations to consider

  • direct immunofluorescence
  • enzyme immunoassay
  • nucleic acid hybridisation tests
  • cell culture

Emerging tests

  • rapid and point-of-care tests

Treatment algorithm

Contributors

Authors

Matthew M. Hamill, MBChB, PhD, FRCP

Assistant Professor of Medicine

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

MMH receives royalties for contributing to UpToDate on Lymphogranuloma venereum and for Clinical Care Options. He has an honorarium from Roche Diagnostics for panel STI & HIV 2021 World Congress (virtual) and was a member of the 2021 Roche group on future of POCT for STI. He has also received consulting fees from GSK for the HSV vaccine.

Acknowledgements

Dr Matthew M. Hamill would like to gratefully acknowledge Dr Anne Rompalo and Dr Christopher K. Fairley, the previous contributors to this topic.

Disclosures

AR and CKF declare that they have no competing interests.

Peer reviewers

Kenneth Lin, MD

Assistant Editor

American Family Physician

Clinical Assistant Professor

GUSOM Medical Officer

US Preventive Services Task Force

Disclosures

KL declares that he has no competing interests.

Lars Jørgen Østergaard, MD, PhD, DMSc

Professor/Head

Department of Infectious Diseases

Aarhus University Hospital

Skejby Sygehus

Aarhus

Denmark

Disclosures

LJO has been funded by Pfizer to write a leaflet on Chlamydia infections.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Nwokolo NC, Dragovic B, Patel S, et al. 2015 UK national guideline for the management of infection with Chlamydia trachomatis. Int J STD AIDS. 2016 Mar;27(4):251-67.Full text  Abstract

Centers for Disease Control and Prevention. Sexually transmitted infections surveillance, 2023. Nov 2024 [internet publication].Full text

Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187.Full text  Abstract

US Preventive Services Task Force. Final recommendation statement. Chlamydia and gonorrhea: screening. Sept. 2021 [internet publication].Full text

Geisler WM, Uniyal A, Lee JY, et al. Azithromycin versus doxycycline for urogenital chlamydia trachomatis Infection. N Engl J Med. 2015 Dec 24;373(26):2512-21.Full text  Abstract

American College of Obstetricians and Gynecologists. Committee opinion no. 737: expedited partner therapy. Jun 2018 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available here.

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