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Genital tract chlamydia infection

Last reviewed: 30 Mar 2025
Last updated: 05 Dec 2024

Summary

Definition

History and exam

Key diagnostic factors

  • asymptomatic
Full details

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
Full details

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
Full details

Diagnostic tests

1st tests to order

  • nucleic acid amplification test (NAAT)
Full details

Tests to consider

  • direct immunofluorescence
  • enzyme immunoassay
  • nucleic acid hybridization tests
  • cell culture
Full details

Emerging tests

  • rapid and point-of-care tests

Treatment algorithm

ACUTE

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.

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

Rowley J, Vander Hoorn S, Korenromp E, et al. Chlamydia, gonorrhoea, trichomoniasis and syphilis: global prevalence and incidence estimates, 2016. Bull World Health Organ. 2019 Aug 1;97(8):548-562P.Full text  Abstract

Centers for Disease Control and Prevention. Sexually transmitted infections surveillance: national overview of STIs, 2022. Jan 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 Differentials
  • Guidelines

    • Reducing sexually transmitted infections
    • Screening for chlamydia and gonorrhea: recommendation statement
    More Guidelines
  • Patient information

    Chlamydia

    More Patient information
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