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.
Differentials
- Lymphogranuloma venereum
- Gonorrhea infection
- Bacterial vaginosis
More DifferentialsGuidelines
- Reducing sexually transmitted infections
- Screening for chlamydia and gonorrhea: recommendation statement
More GuidelinesPatient information
Chlamydia
More Patient information- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer