Frequently Asked Questions
Table of Contents
- Who should be tested and how often should they be tested?
- What is the preferred specimen?
- Is there a need to collect the first urine sample in the morning?
- Do Thin Preps provide the same sensitivity as a cervix swab or urine test?
- What is the sensitivity of a urine test?
- What is the specificity of a urine test?
- Is a test for clearance or a test for cure required?
- How long can chlamydia infection persist if left untreated?
- What symptoms can result from chlamydia infection?
- What are the possible complications of chlamydia infection?
- Can vertical transmission occur?
- What is the incubation period?
- How should sexual partners of patients with chlamydia be managed?
- How can partner notification for chlamydia be performed?
Who should be tested and how often should they be tested?
The following people should be offered routine testing at least annually:
- sexually active men and women under the age of 25
- men who have sex with men
- sex industry workers
Testing is also recommended for people who have:
- a history of inconsistent condom use
- recent partner change
- unplanned pregnancy
- symptoms suggestive of chlamydia
- another STI
- a sexual partner with chlamydia
The frequency of further testing should be based on an assessment of continuing risk factors.
What is the preferred specimen?
For men: Initial stream urine taken at any time of the day.
For women: Initial stream urine or a cervical swab. Other options include a Thin Prep specimen, or a high vaginal swab.
A rectal swab is also indicated for men and women who have had receptive anal sex.
Urine should ideally be collected 1 to 2 hours after the last void. In practice, patients should not be asked to delay collection if this may result in no sample being available.
Is there a need to collect the first urine sample in the morning?
No, a urine sample can be collected at any time of the day.
Do Thin Preps provide the same sensitivity as a cervix swab or urine test?
Current evidence indicates that Thin Preps provide similar sensitivity to a cervical swab or a urine specimen.
What is the sensitivity of a urine test?
The chlamydia PCR is highly sensitive; in excess of 95%.
What is the specificity of a urine test?
The chlamydia PCR is highly specific; in excess of 95%.
Is a test for clearance or a test for cure required?
No, this is not routinely required as the treatment is highly effective.
In pregnancy a test of cure is recommended at 4 weeks, particularly if azithromycin was not used.
A second test should not be conducted within 4 weeks of the initial test due to the likelihood of bacterial DNA still being present.
- In all patients, a repeat test should be conducted 3-6 months later because of the high risk of reinfection.
How long can chlamydia infection persist if left untreated?
Asymptomatic chlamydia infections can potentially persist for several years if untreated, thereby adding to the pool of infection within the community.
What symptoms can result from chlamydia infection?
Up to 90% of cases in men and women will be asymptomatic. Men may experience urethral discharge, pain on urination or urethral irritation. Women may experience intermenstrual or post coital bleeding, pain on urination, and lower abdominal pain may be present.
What are the possible complications of chlamydia infection?
Untreated chlamydia can lead to pelvic inflammatory disease (PID) in women. The long term complications of PID include infertility, ectopic pregnancy and chronic pelvic pain. Men may develop epididymo-orchitis. Chlamydia infection also increases the risk of HIV transmission. Other possible complications include conjunctival infection and Reiter’s syndrome.
Can vertical transmission occur?
Yes. If untreated in pregnancy, chlamydia can be transmitted to the neonate. Possible sequelae include conjunctivitis and pneumonia.
What is the incubation period?
The incubation period is 2-60 days. However, as most people with chlamydia have no symptoms it is usually not possible to determine how long someone has had chlamydia or where the infection was acquired.
How should sexual partners of patients with chlamydia be managed?
All sexual contacts from the previous 6 months should be tested for chlamydia and other STIs and treated empirically for chlamydia regardless of test results. Testing for chlamydia is recommended so that those with confirmed infection are then able to inform their other sexual contacts.
How can partner notification for chlamydia be performed?
People with chlamydia may be prepared to tell their own partners. Clinicians can download a letter from this website for patients to use, or direct them to this site. If the person with chlamydia wishes, a third party may notify the partners. This can be the doctor providing care or the local sexual health clinic.