Summary
Definition
History and exam
Key diagnostic 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 socioeconomic status
Diagnostic tests
1st tests to order
- nucleic acid amplification test (NAAT)
Tests to consider
- direct immunofluorescence
- enzyme immunoassay
- nucleic acid hybridization tests
- cell culture
Emerging tests
- rapid and point-of-care tests
Treatment algorithm
confirmed or suspected
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
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 to users with access to all of BMJ Best Practice.
Differentials
- Lymphogranuloma venereum
- Gonorrhea infection
- Bacterial vaginosis
More DifferentialsGuidelines
- 2025 European guideline on the management of Chlamydia trachomatis infections
- Reducing sexually transmitted infections
More GuidelinesPatient information
Chlamydia
More Patient information
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