Clinical Review

Screening and treatment of Chlamydia trachomatis infections

BMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c1915 (Published 21 April 2010) Cite this as: BMJ 2010;340:c1915
  1. Sebastian Kalwij, general practitioner and general practitioner lead12,
  2. Mary Macintosh, director 2,
  3. Paula Baraitser, medical adviser 2
  1. 1Waldron Teaching Practice, Lewisham, London SE8 4BG
  2. 2National Chlamydia Screening Programme, Centre for Infectious Diseases, Health Protection Agency, London NW9 5EQ
  1. Correspondence to: S Kalwij sebastiankalwij{at}mac.com
  • Accepted 1 April 2010

Summary points

  • Chlamydia is most common in people aged 16-25 and is usually asymptomatic

  • Untreated infection can cause pelvic inflammatory disease, ectopic pregnancy, and subfertility

  • Nucleic acid amplification testing is highly sensitive on non-invasive samples such as urine and self taken vaginal swabs

  • Mathematical modelling suggests that screening could reduce the prevalence of infection

  • The English national chlamydia screening programme aims to test all sexually active under 25s by offering tests in general practice, pharmacies, sexual and reproductive health services, and other venues they visit

  • Partners and ex partners of test positive patients should be tested and treated

Chlamydia trachomatis is the most commonly diagnosed bacterial sexually transmitted infection worldwide.1 2 Numbers of diagnoses have increased over the past 10 years as a result of more sensitive tests and increased testing. Genital infection with C trachomatis is asymptomatic in 50-88% of men and women,w1 and 46% of infections clear spontaneously within a year.3

Sources and selection criteria

We searched Medline databases for Chlamydia trachomatis, chlamydia screening, pelvic inflammatory disease, and ectopic pregnancy. We looked at guidelines from the National Institute for Health and Clinical Excellence and the Scottish Intercollegiate Guidelines Network, in addition to reports from the European Centre for Disease Prevention and Control, the US Centers for Disease Control and Prevention, and World Health Organization.

Persistent chlamydia infection can lead to pelvic inflammatory disease, ectopic pregnancy, and tubal infertility in womenw2 and epididymitis and epididymo-orchitis in men.2 Here, we describe the diagnosis and management of chlamydia and discuss control strategies. Guidance on the laboratory diagnosis and treatment of chlamydia has a strong evidence base, but evidence on the natural course of infection and optimum control strategies is less robust.

How common is chlamydia infection and who gets it?

Infection can occur at any age but is most common in people under 25,w3 with rates of diagnosis peaking …

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