• Most infected females are asymptomatic; possible symptoms are:
  • Vaginal discharge
  • Dysuria
  • Lower abdominal pain
  • Abnormal vaginal bleeding (postcoital or intermenstrual) or breakthrough bleeding
  • Dyspareunia
  • Conjunctivitis
  • Proctitis
  • Reactive arthritis



  • Finding of lower abdominal tenderness or cervical motion tenderness should prompt the attending physician to evaluate the patient for salpingitis &/or endometritis which are part of PID
    • Treat patient accordingly (See Pelvic Inflammatory Disease Management Chart for details)
  • Differential diagnoses may also include other surgical or gynecological conditions



  • Syndromic management approach may be used in health care facilities where equipment & trained personnel for determining STI etiology are not available
  • Syndromic management is based on consistent groups of symptoms & easily recognized signs, & treatment will cover the most common or serious organisms involved in causing the syndrome
    • Using syndromic management in cases of vaginal discharge is limited esp if cervical infections are the cause (gonococcal or Chlamydia)

Clinical Observations Associated w/ Cervical Infections

  • Cervical mucopus
  • Cervical ectropion
  • Cervical friability
  • Bleeding between menses or during sexual intercourse

Lab Tests

  • If resources permit, lab tests to screen women w/ vaginal discharge should be considered
    • In patients who undergo a speculum exam, endocervical or vaginal swabs may be sent for testing
    • If a speculum exam is not done, consider sending self-obtained low vaginal swab or 1st-void urine for testing
  • Urine or rectal swab specimen may also be used, if appropriate
  • Test utilized will depend on available resources
  • Diagnosis is confirmed if C trachomatis is isolated by culture or demonstrated in a specimen through antigen or nucleic acid detection

Lab Exams for C trachomatis

  • Nucleic acid amplification tests (NAAT)
    • Recommended test for detection of chlamydial infection of genital tract
    • Most sensitive (90-95%) & specific
    • Test of choice for cervical, urethral, 1st-void urine specimens
      • Recommended specimen from women is a self- or physician-obtained vaginal swab
  • Cell culture
    • Recommended for throat & rectal specimens
    • May be used when blood & mucus interfere w/ NAAT result
    • Though highly specific, high cost & low sensitivity (60-80%) preclude routine use
  • Routine use of the following lab tests is not recommended:
    • Direct fluorescent antibody test: Not to be used for routine testing of specimen from the genital tract
    • Nucleic acid hybridization or probe test: Assays are not widely available
    • Enzyme immunoassays: False-positive results may occur due to cross-reactivity among chlamydial species
    • Serological test: Not to be used for screening since prior chlamydial infection may or may not generate a systemic antibody response


Diagnosis of Lymphogranuloma Venereum (lgv)

  • Clinical signs & symptoms as described in clinical presentation
  • Bubo aspiration
    • Milky fluid in aspirate
    • May require sterile saline injection for aspiration
  • Direct detection by NAAT, culture, or direct immunofluorescence
    • Genital lesion swab, rectal swab or bubo aspirate may be used
    • Culture is the most specific test but may not be widely available
  • Serology
    • High antibody titers are suggestive of LGV in a patient w/ symptoms consistent w/ LGV, but low titers do not rule out the diagnosis
    • Complement fixation titer of ≥1:64 in the relevant clinical setting is consistent w/ LGV
  • Exclusion of other causes of inguinal lymphadenopathy
    • Non-sexually transmitted local & systemic infections (eg those of the lower limb or TB lymphadenopathy) can also cause inflammation of the inguinal lymph nodes
  • Because definite diagnostic testing is lacking, patients w/ symptoms consistent w/ LGV (ie proctocolitis or genital ulcer w/ lymphadenopathy) should receive treatment for LGV