Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 13 Sept 2026Clinical review pending
Saved on this device
!
Look beyond uncomplicated infection
Severe pelvic pain, peritonism, fever, pregnancy pain, acute scrotal pain or a painful red eye may represent PID, ectopic pregnancy, torsion, epididymo-orchitis or sight-threatening ocular infection.
Action: Assess the time-critical differential immediately, obtain pregnancy and site-specific tests without delaying syndrome-based treatment, and involve gynaecology, urology or ophthalmology as the presentation requires.
Synopsis
Diagnose site-specific Chlamydia trachomatis infection, treat uncomplicated disease with the current regimen, and complete pregnancy, follow-up and partner management safely.
Many genital, rectal and pharyngeal infections are asymptomatic; test the anatomy exposed rather than relying on symptoms or identity labels.
Use NAAT: a self-taken vulvovaginal swab is preferred for a vagina, while first-catch urine is preferred for a penile urethra; add rectal or pharyngeal samples according to exposure and symptoms.
If an initial test follows exposure within two weeks, test now and repeat NAAT at two weeks after exposure; notify partners since and in the four weeks before symptom onset for symptomatic penile urethral infection (or the last partner if longer), and use the preceding six months for every other presentation.
Key red flags
Pelvic pain with cervical motion, uterine or adnexal tenderness meets a low threshold for empirical pelvic inflammatory disease treatment.
A positive pregnancy test with pain, bleeding, syncope or shoulder-tip pain requires urgent ectopic-pregnancy assessment.
Sudden severe unilateral scrotal pain or abnormal testicular lie requires emergency torsion review before an infection label is accepted.
Eye pain, photophobia, reduced vision or marked conjunctival inflammation needs same-day specialist assessment and an ocular sample.
Rectal pain, bloody discharge, tenesmus or systemic lymphadenopathy should prompt consideration of lymphogranuloma venereum rather than a seven-day uncomplicated regimen.
Upper-tract complication
Lower abdominal pain, deep dyspareunia and cervical or adnexal tenderness suggests PID and needs immediate broad syndrome treatment.
Investigation priorities
01
Site-specific chlamydia NAATFirst step
Detect C. trachomatis at genital, rectal, pharyngeal or ocular sites selected from anatomy and exposure.
Management branches
DETECTTest the relevant anatomy
A patient has symptoms, screening eligibility, a new exposure or notification as a chlamydia contact.
Take a private sexual history that records anatomy, exposure sites, timing, symptoms, pregnancy possibility, contraception and recent antimicrobials.
Obtain a vulvovaginal swab or first-catch urine as appropriate, adding rectal, pharyngeal or conjunctival NAAT when exposure or presentation requires it.
Key medicines
DoxycyclineTake 100 mg orally twice daily for seven days for uncomplicated genital, rectal or pharyngeal infection.Review pregnancy, allergy and interactions with antacids or iron; counsel on water, remaining upright after dosing, photosensitivity and course completion.
Azithromycin in pregnancyGive 1 g orally once followed by 500 mg daily for two days when this current pregnancy regimen is selected.Check QT risk, macrolide interactions and vomiting; a one-dose alternative is separately graded and requires the guideline context and test of cure.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 13 Sept 2026; clinical approval remains outstanding.
BASHH chlamydia guideline 2026Published 2026; scope, sites, NAAT, treatment, pregnancy, TOC, retesting and partner sections read 13 Sept 2026. Mainly people aged 16 or older in UK sexual-health services.