Chlamydia Symptoms, Diagnosis, and Treatment: When to See a Healthcare Provider

Chlamydia trachomatis is the most common bacterial STI. Most infections are asymptomatic.

Symptoms (When Present)

• Women: Cervicitis → mucopurulent discharge, intermenstrual bleeding, dysuria. Ascending infection → PID (pelvic pain, fever, infertility risk).
• Men: Urethritis → watery/mucoid discharge, dysuria, urethral itching. Epididymitis → testicular pain/swelling.
• Rectal: Proctitis (pain, discharge, bleeding) — receptive anal sex.
• Pharyngeal: Usually asymptomatic.

Diagnosis

NAAT (Nucleic Acid Amplification Test) on urine (first-catch) or swabs (cervical, urethral, rectal, pharyngeal) — gold standard. Results in hours.

Treatment

• First-line: Doxycycline 100 mg PO BID × 7 days.
• Alternative (pregnancy): Azithromycin 1 g PO single dose.
• Test-of-cure: Not routine; recommended at 3–4 weeks for pregnancy, rectal infection, or if adherence uncertain.

Partner Management

Expedited Partner Therapy (EPT) — provide medication/prescription to partners without clinical evaluation — legal in most states. Abstain until both partners complete treatment and symptoms resolve.

Screen for co-infections (gonorrhea, syphilis, HIV). Retest at 3 months (high reinfection rate).