Chlamydia

• Chlamydia trachomatis (See also Lymphogranuloma venereum)

See STI Atlas for images.

Special considerations

May also infect the eye, anus and throat.

NAAT – Nucleic acid amplification test

Specimen collection guidance

Clinician collected | Self-collection

Asymptomatic patients can collect most samples themselves, including vaginal swabs, anorectal and throat swabs.

Investigations 

• NAATs are highly sensitive, can be used in non-clinical settings and are the only recommended test for chlamydia.
• For asymptomatic testing or where an examination is unable to be performed, encourage patient self-collection of vaginal swabs and anorectal swabs.
• Concurrent gonorrhoea testing should accompany chlamydia testing.

BD: twice a day

PO: orally

Stat.: immediately

Treatment advice

• See urethritis for immediate management of urethritis symptoms.
• Immediate treatment is not recommended for all sexual contacts of chlamydia but offer testing of exposed anatomical sites and await results.
• If contact treatment is initiated, use recommended treatment. Only use azithromycin if adherence likely to be poor or matches index case treatment. See Contact tracing below
• If a patient has an IUD, leave it in place and treat as recommended. Seek specialist advice as needed.

For symptomatic anorectal infection, see testing and treatment recommendations.

Other immediate management

• Perform a full STI check-up including HIV and syphilis serology if not done as part of initial testing.
• Advise no sexual contact for 7 days after treatment is commenced, or until the course is completed and symptoms resolved, whichever is later.
• Advise no sex with partners from the last 6 months until the partners have been tested and treated if necessary.
• Contact tracing and patient delivered partner therapy (see contact tracing section for more information).
• Provide patient with factsheet.
• Notify the state or territory health department.

Special considerations

• Consider seeking specialist advice before treating any complicated presentation.

BD: twice a day

PO: orally

Stat.: immediately

IMI: intramuscular injection

• Contact tracing is important to prevent re-infection and reduce transmission.
• All partners should be traced back for 6 months.
• The diagnosing doctor is responsible for initiating and documenting a discussion about contact tracing.
• Offer testing of exposed anatomical sites to all sexual contacts.
• Consider presumptive treatment if there has been sexual contact within the past 2 weeks or when the person’s individual circumstances mean later treatment may not occur.

Patient delivered partner therapy

• Patient delivered partner therapy is a partner notification and treatment method whereby antibiotic treatment is prescribed or supplied for the sexual partner/s of a patient diagnosed with chlamydia infection (index patient). The index patient delivers the prescription or treatment to their partner/s.
• Consider using patient delivered partner therapy which is approved in some jurisdictions for heterosexual index patients with anogenital or oropharyngeal chlamydia whose partners are unlikely to seek chlamydia testing or treatment, or with repeat infections whose partners have not been treated.
• Patient delivered partner therapy guidance is available in Victoria, NSW, and the NT.

See Australasian Contract Tracing Guideline – Chlamydia, for more information.

• To confirm patient adherence with treatment and assess for symptom resolution.
• To confirm contact tracing procedures have been undertaken or offer more contact tracing support.
• Educate about condom use, contraception, HIV PrEP/PEP, safe injecting practices, consent, CST and vaccinations for HAV, HBV and HPV as indicated.

Test of cure

Not routinely recommended, except for:

• Pregnant people
• Anorectal infection treated with Azithromycin

Test of cure by nucleic acid amplification test (NAAT) in these situations should be performed no earlier than 4 weeks after treatment is completed to prevent false positive result due to persistent chlamydia DNA.

Test for re-infection

• Re-infection is common
• Retesting at 3 months is recommended to detect re-infection.

Consider testing for other STIs if not undertaken at first presentation or retesting after the window period.

• 100% of patients diagnosed with chlamydia are treated with an appropriate antibiotic regimen.

• CPD – All CTMx Activities (PDF)
• Autofill Template – Best Practice (PDF)
• Autofill Template – Medical Director (PDF)
• CTMx Autofill Template (PDF)
• CTMx Autofill Template (RTF)
• PIDMx Autofill Template (PDF)
• PIDMx Autofill Template (RTF)
• Chlamydia Factsheet (PDF)
• Instructions for Inserting Patient Education Resources (PDF)
• PID Factsheet (PDF)
• MoCCA Tips for Retesting (PDF)
• Practical Tips for Chlamydia Partner Notification (PDF)
• Patient Delivered Therapy – AJGP (PDF)
• Streamlining Medical Records – AJGP (PDF)
• New Best Practice Guidance – AJGP (PDF)

These resources were developed as part of the Management of Chlamydia Cases in Australia (MoCCA) Study, that was funded by the National Health and Medical Research Council (APP1150014, 2018–2024). Based at the University of Melbourne, the study was a collaboration between the University and our project investigators and partner organisations in Victoria, New South Wales and Queensland.