Chlamydia trachomatis: updated management guidelines

Human infection with Chlamydia trachomatis results in a wide spectrum of disease, a large proportion of which is asymptomatic, so a high index of suspicion is necessary to detect infection. Patients who should be tested for chlamydial infection include those with sexually transmitted diseases (STDs) or with a history of contact with an STD; those whose sexual history suggests a significant risk of chlamydial infection, especially if aged <25 years and with recent new sexual partners or with multiple partners; and women about to undergo certain gynaecological procedures. Laboratory diagnosis is neither simple nor cheap, and both false positive and false negative results may occur. The choice of which specimens to take and which tests to use for diagnosis has been made more complex since the availability of nucleic acid tests. Practitioners should be aware of the limitations of chlamydial tests, especially in low prevalence populations. Management is relatively straightforward. Prompt and adequate treatment should avert the possible serious complication that may occur especially in women. This paper aims to optimise testing and management programs by considering criteria by which patients are selected for chlamydial testing, and by giving practical guidelines for management. (author abstract)