Synopsis
Test and treat three important sexually transmitted infections with site-specific diagnostics, resistance-aware regimens, pregnancy modifications, partner care and accurate follow-up advice.
- Chlamydia and gonorrhoea are frequently asymptomatic; test with NAAT at exposed genital and rectal sites rather than relying on symptoms or identity labels, and include pharyngeal testing for every person diagnosed with urogenital gonorrhoea and every gonorrhoea contact under the 2025 guideline.
- A self-taken vulvovaginal swab is the preferred genital specimen for chlamydia and gonorrhoea NAAT in women and is generally more sensitive than urine.
- Obtain gonococcal culture before treatment whenever feasible so susceptibility can be measured, but never postpone indicated therapy in a patient unlikely to return or clinically unwell.
- Treat uncomplicated chlamydia with doxycycline 100 mg orally twice daily for seven days unless contraindicated; pregnancy requires a pregnancy-compatible alternative regimen.
- Treat uncomplicated anogenital or pharyngeal gonorrhoea with ceftriaxone 1 g intramuscularly once under current BASHH guidance; alternatives depend on susceptibility and specialist advice.
- Treat trichomoniasis with metronidazole 400 to 500 mg orally twice daily for seven days; the 2 g single dose is less effective and is an alternative rather than the preferred regimen.
- Organism-specific partner notification, abstinence and follow-up differ: avoid a single generic STI instruction and record the advice actually given.
- Screen for coexisting HIV, syphilis and other STIs according to exposure, offer vaccination where appropriate and use non-stigmatising prevention counselling.
Key red flags
Lower abdominal pain with cervical excitation or adnexal tenderness should be treated as possible pelvic inflammatory disease while tests are pending.
Pregnancy with pelvic pain, bleeding, syncope or shoulder-tip pain requires urgent exclusion of ectopic pregnancy.
Fever with migratory polyarthralgia, tenosynovitis, pustular lesions or septic arthritis suggests disseminated gonococcal infection.
Severe eye pain, purulent conjunctivitis or visual change after sexual exposure needs same-day ophthalmological and microbiological assessment.
Neurological symptoms, severe immunosuppression or inability to tolerate oral therapy requires specialist and sometimes inpatient care.
Investigation priorities
Detect infection sensitively at each anatomical site exposed during sex.
Management branches
There are symptoms, a notified exposure, screening eligibility or a partner diagnosis.
- Establish exposure sites, last contact, symptoms, pregnancy possibility and any antibiotics already taken.
- Offer self-taken vulvovaginal NAAT plus rectal or pharyngeal sampling according to exposure, and obtain gonococcal culture before treatment where feasible.
- Add trichomonas, HIV, syphilis and other testing according to phenotype and risk, with a repeat plan for tests taken within a window period.