Chlamydia (uncomplicated) in Primary Care (Guidelines)

Chlamydia infection is a common sexually transmitted infection, and is often asymptomatic. Testing is recommended where there has been a change in sexual parter(s), or signs and symptoms of urethritis, cervicitis, pelvic inflammatory disease or epididymo-orchitis, or if the person requests testing. Extra-genital infection of pharynx or rectum is also common, but is more often asymptomatic. Chlamydia infection can cause significant short- and long-term morbidity. Complications of infection include pelvic inflammatory disease (PID), tubal infertility and ectopic pregnancy.

Common symptoms of chlamydia include dysuria, urethral discharge or abnormal vaginal discharge, intermenstrual/post-coital bleeding, testicular pain or pelvic pain.

Sexual History

Prevalence is highest in people under 25 years of age, and in people with frequent partner change. However, there may be no obvious risk factors disclosed. 

Diagnostics

Testing is with Dual NAAT for Chlamydia and Gonorrhoea, and sample sites are according to anatomy and sexual history:

• Asymptomatic women/people with a vagina: Self-obtained lower vaginal swab (SOLVS) +/- Pharyngeal swab, +/- Rectal swab
• Asymptomatic heterosexual men/people with a penis: First void urine
• Men Who have sex with men: Rectal swab, pharyngeal swab and first void urine
• Full STI screening, including chlamydia, gonorrhoea (urine/swab(s)), HIV and syphilis (serum blood sample) should be offered to everyone presenting with symptoms or risk of STI, or requesting STI screening

Advise to offer testing to all current and recent partners in preceding 3 months.

Prescribing

See antimicrobial guidelines: Chlamydia Trachomatis/Urethritis

Test of Cure

• Not routinely required
• Test of re-infection is recommended at 12 weeks for people under 25 and those with change of partner
• Test of cure is recommended in pregnancy, where symptoms persist or poor compliance suspected.

• URGENT referral: Call 01463 888 300, and choose option “Health Professional”
• Non-Urgent Referral: to Sexual Health via SCI gateway or by emailing nhsh.hsh-healthadvisor@nhs.scot
• Referral for partner notification: Highland Sexual Health referral service