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

Initial assessment and referral: For patients presenting with symptoms suggestive of chlamydia or gonorrhoea, refer them to a genito-urinary medicine (GUM) clinic or specialist sexual health service for confirmation of diagnosis and management whenever possible. If the patient is unable or unwilling to attend, management can be initiated in primary care with appropriate treatment and advice ¹,².

Empirical treatment: For suspected uncomplicated genital chlamydia infection in non-pregnant adults and children over 13 years, first-line treatment is doxycycline 100 mg twice daily for 7 days. If doxycycline is contraindicated or not tolerated, azithromycin or erythromycin are alternatives. For men with suspected urethritis, empirical treatment with doxycycline is recommended, with azithromycin or ofloxacin as alternatives if doxycycline is contraindicated ¹,².

Gonorrhoea consideration: If gonococcal infection is suspected (e.g., local outbreak or clinical features), consider treatment for gonorrhoea and refer urgently to GUM for confirmation and management ².

Partner notification and prevention: Advise patients that all recent sexual partners should be notified, tested, and treated to prevent reinfection and onward transmission. Partner notification should be supported by specialist services if needed. Patients should abstain from sexual intercourse (including oral sex) until they and their partners have completed treatment or waited the recommended period after treatment ¹,²,³.

Screening and follow-up: Encourage screening for other STIs including HIV, hepatitis B, and syphilis. Test of cure is not routinely recommended for uncomplicated chlamydia but is indicated in pregnancy, suspected poor compliance, or persistent symptoms. Repeat testing 3–6 months after treatment is advised for people under 25 years or those at high risk ¹.

Patient information and support: Provide written information about the infection, transmission, treatment, complications, and prevention measures. Emphasize confidentiality, non-judgmental care, and support access to services ¹,³.