When should I consider referring a patient with recurrent Chlamydia infections to a specialist?

Consider referring a patient with recurrent Chlamydia infections to a specialist genito-urinary medicine (GUM) clinic or local specialist sexual health service if:

• There is no response to first-line treatment, indicating possible treatment failure or complications.
• Symptoms persist or recur after treatment completion, despite adherence and partner treatment being confirmed.
• Pelvic inflammatory disease (PID) is suspected, as this requires urgent specialist assessment.
• There is doubt about the diagnosis or alternative causes of symptoms need exclusion.
• The patient is a child or young person with suspected or confirmed STI, where safeguarding concerns may apply.
• Repeated infections occur, especially in high-risk groups or if reinfection cannot be prevented through partner notification and treatment.

Referral is important because specialist services can provide comprehensive STI screening, partner notification support, further investigations, and tailored management plans that are beyond primary care scope.

Strongly advise referral particularly if symptoms persist after appropriate antibiotic regimens or if complex infections such as non-gonococcal urethritis with Mycoplasma genitalium are suspected.

Additionally, if the patient declines or is unable to attend a GUM clinic, primary care should still manage uncomplicated cases but maintain a low threshold for specialist advice or referral.

Ensure partner notification and treatment are addressed to reduce reinfection risk before or alongside referral.

In pregnancy or complex cases, multidisciplinary discussion with specialists is recommended.

Overall, recurrent or persistent chlamydia infections warrant specialist referral to ensure accurate diagnosis, effective treatment, and prevention of complications and onward transmission.

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