How should I approach the management of a patient presenting with symptoms suggestive of chlamydia or gonorrhoea?

Initial assessment and referral: For any patient aged 13 years or older presenting with symptoms suggestive of chlamydia or gonorrhoea, strongly recommend referral to a genito-urinary medicine (GUM) clinic or local specialist sexual health service for comprehensive management and testing for other STIs including HIV, hepatitis B, and syphilis. If the patient is unwilling or unable to attend, management can be undertaken in primary care if appropriate expertise and local protocols are in place ¹,².

Testing and diagnosis: Take appropriate samples for nucleic acid amplification tests (NAATs) to confirm chlamydia and gonorrhoea infection. For gonorrhoea, ideally obtain a culture before antibiotic treatment to test for antimicrobial susceptibility ². For urethritis symptoms in men, consider urethral smear or first-pass urine for diagnosis and refer to GUM for microscopy if possible ³.

Treatment: For uncomplicated genital chlamydia in non-pregnant adults and children over 13 years, first-line treatment is doxycycline 100 mg twice daily for 7 days. Alternatives include azithromycin or erythromycin if doxycycline is contraindicated or not tolerated. Pregnant women require specialist advice and alternative regimens such as azithromycin or erythromycin ¹.

For gonorrhoea, if antimicrobial susceptibility is unknown, treat with ceftriaxone 1 g intramuscularly as a single dose. If susceptibility is known and fluoroquinolones are appropriate, ciprofloxacin 500 mg orally as a single dose may be used, but fluoroquinolones are generally restricted due to safety concerns ².

Partner notification and prevention: Advise patients that all current sexual partners must be notified, tested, and treated to prevent reinfection and onward transmission. Discuss partner notification methods and offer referral to specialist services for support with contact tracing ¹,⁴.

Follow-up: Arrange follow-up to assess treatment adherence, symptom resolution, and partner notification. Test of cure is not routinely required for uncomplicated chlamydia but is indicated in pregnancy, suspected poor compliance, or persistent symptoms. Repeat testing 3–6 months after treatment is recommended for people under 25 years or those at high risk ¹.

Urgent referral: Urgently refer patients who do not respond to first-line treatment, have suspected pelvic inflammatory disease, disseminated gonorrhoea, or complications ¹,².