Synopsis
Diagnose chlamydial and gonococcal infection at every exposed anatomical site, preserve gonococcal susceptibility, treat with current UK regimens and prevent reinfection through partner care.
- Chlamydia is often asymptomatic but can cause cervicitis, urethritis, PID, epididymo-orchitis and reactive arthritis.
- Gonorrhoea frequently causes purulent urethral or cervical discharge but pharyngeal and rectal infection are commonly silent.
- Take NAAT from every exposed site: vulvovaginal swab or first-catch urine, plus rectal or pharyngeal samples according to sexual history.
Key red flags
Pelvic pain with cervical excitation or adnexal tenderness requires immediate PID treatment before NAAT results.
Pelvic pain, deep dyspareunia, cervical excitation, testicular pain or epididymal swelling indicates spread beyond uncomplicated infection.
Investigation priorities
Detect chlamydia and gonorrhoea from the genital site with a validated molecular assay.
Management branches
There is STI exposure, genital discharge, dysuria, bleeding or a partner notification.
- Take a confidential sexual history covering vaginal, anal and oral exposure, symptoms, contraception, pregnancy possibility and safeguarding.
- Collect genital or urinary NAAT plus rectal and pharyngeal samples where exposed, before antibiotics when clinically safe.
Key medicines
Doxycycline for uncomplicated chlamydiaGive 100 mg orally twice daily for seven days in a suitable non-pregnant adult with uncomplicated genital, pharyngeal or rectal infection.
Ceftriaxone for uncomplicated gonorrhoeaGive 1 g intramuscularly as a single dose when susceptibility is unknown, following the current UK gonorrhoea guideline.