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.
- When gonorrhoea is suspected, obtain culture before treatment so antimicrobial susceptibility is preserved.
- Use doxycycline 100 mg orally twice daily for seven days for uncomplicated chlamydia in a suitable non-pregnant adult.
- Use ceftriaxone 1 g intramuscularly once for uncomplicated gonorrhoea when susceptibility is unknown under current UK guidance.
- If chlamydia has not been excluded, add effective chlamydia treatment rather than assuming ceftriaxone covers it.
- Arrange partner notification, abstinence until the advised interval after both patient and partners complete treatment, and site-specific test of cure when indicated.
Key red flags
Pelvic pain with cervical excitation or adnexal tenderness requires immediate PID treatment before NAAT results.
Acute unilateral testicular pain or swelling needs urgent torsion exclusion before attributing symptoms to epididymitis.
Hot joints, tenosynovitis, pustular skin lesions or fever suggests disseminated gonococcal infection.
Purulent conjunctivitis with gonococcal risk threatens rapid corneal damage and needs emergency ophthalmology.
Pregnancy with pain, bleeding or suspected cervical infection requires same-day maternity and sexual-health review.
Pharyngeal gonorrhoea, persistent symptoms or suspected treatment failure requires culture, test of cure and specialist resistance management.
Pelvic pain, deep dyspareunia, cervical excitation, testicular pain or epididymal swelling indicates spread beyond uncomplicated infection.
Migratory arthralgia, tenosynovitis, sparse pustules and later septic arthritis can occur with minimal genital symptoms.
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.
- If gonorrhoea is suspected or NAAT positive, obtain culture from every positive or symptomatic site for susceptibility.
- Offer HIV and syphilis testing, hepatitis assessment and vaccination or PrEP discussion according to exposure.