Chlamydia Symptoms, Testing, and Treatment: What You Need to Know
Chlamydia trachomatis is the most common bacterial STI globally. Most infections are asymptomatic, but when symptoms occur, they differ by site and sex.
Common Symptoms
| Site | Women | Men |
|---|
| Urogenital | Cervicitis: mucopurulent discharge, intermenstrual bleeding, dysuria, pelvic pain. Often asymptomatic. | Urethritis: clear/mucoid discharge, dysuria, urethral itching. Often asymptomatic. |
| Rectal | Proctitis: discharge, pain, bleeding, tenesmus. Often asymptomatic. |
| Pharyngeal | Usually asymptomatic; sore throat possible. |
| Ocular | Conjunctivitis (trachoma in endemic areas; inclusion conjunctivitis in neonates/adults). |
Note: Chlamydia does not typically cause genital ulcers or sores (unlike herpes, syphilis, chancroid).
Complications of Untreated Infection
- Women: Pelvic inflammatory disease (PID) → tubal factor infertility, ectopic pregnancy, chronic pelvic pain.
- Men: Epididymitis, prostatitis, reactive arthritis.
- Neonates: Ophthalmia neonatorum, pneumonia.
- Increased HIV acquisition/transmission risk.
Diagnosis and Treatment
- Test: NAAT (nucleic acid amplification test) on urine, vaginal/urethral/rectal/pharyngeal swabs. Most sensitive/specific.
- Treat: Doxycycline 100 mg PO BID × 7 days (preferred) OR Azithromycin 1 g PO single dose (alternative).
- Partner Treatment: Expedited partner therapy (EPT) or referral for all partners within 60 days.
- Test of Cure: Not routinely needed except in pregnancy (repeat at 4 weeks), rectal infection, or persistent symptoms.
- Retest: At 3 months due to high reinfection rate.
Abstain from sex until 7 days after treatment completion (both partners).
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