References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Chlamydial urethritis is an infection of the urethra in men caused by Chlamydia trachomatis. It’s the most common cause of non-gonococcal urethritis (NGU) and one of the most frequently diagnosed STIs in UK sexual health clinics. Many men have no symptoms, but when present, the classic signs are discharge and a burning sensation when urinating.
If you’ve been diagnosed with chlamydial urethritis or have symptoms suggestive of it, this guide covers what to expect from testing, treatment, and follow-up.
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Symptoms
Around 50% of men with chlamydial urethritis have no symptoms. When symptoms appear, they usually develop 1-3 weeks after exposure:
- Clear, white, or slightly cloudy discharge from the penis (often most noticeable in the morning)
- Burning or stinging when urinating
- Itching or irritation at the tip of the urethra
- Mild testicular discomfort (if epididymitis develops)
Compared to gonococcal urethritis (caused by gonorrhoea), chlamydial urethritis tends to produce milder symptoms: thinner discharge, less pain, and a more gradual onset.
How Is It Diagnosed?
- First-void urine NAAT test: The standard test. You provide a urine sample (first urine of the day, or at least 1-2 hours since you last urinated). The lab tests specifically for Chlamydia trachomatis DNA.
- Urethral swab: Occasionally used if a urine sample can’t be obtained or if microscopy is needed to confirm inflammation.
Chlamydia testing is highly accurate: NAAT tests have 97-99% sensitivity and over 99.5% specificity. A positive result is almost certainly a true positive. Test from 2 weeks after potential exposure for reliable results.
Treatment
Chlamydial urethritis is fully curable with antibiotics:
First-line: Doxycycline
100mg twice daily for 7 days. This is now the preferred treatment based on recent BASHH guidance, as it has a slightly higher cure rate than single-dose azithromycin for urethral chlamydia.
Alternative: Azithromycin
1g single dose, or the extended course (500mg day 1, then 250mg daily days 2-5). Used when doxycycline is contraindicated (e.g., pregnancy, allergy).
Important points:
- Complete the full course even if symptoms resolve quickly
- Avoid sex for 7 days after starting treatment
- Your sexual partner(s) must also be tested and treated
- A test of cure is not routinely needed, but retesting at 3-6 months is recommended to check for reinfection
Read more: Doxycycline | Azithromycin
What If Treatment Doesn’t Work?
If symptoms persist after completing doxycycline:
- Retest for chlamydia (possible reinfection from untreated partner)
- Test for Mycoplasma genitalium (a common cause of persistent NGU)
- Test for ureaplasma and trichomoniasis
- Consider non-infectious causes (chemical irritation, chronic prostatitis)
Complications of Untreated Chlamydial Urethritis
- Epididymitis: Infection spreads to the epididymis (tube behind the testicle), causing pain, swelling, and potentially reduced fertility
- Reactive arthritis: Rare. Joint pain, eye inflammation, and urethritis triggered by the immune response to chlamydia
- Transmission to partners: Untreated chlamydia in men can cause cervicitis, PID, and infertility in female partners
Read more: What is chlamydia? | Chlamydia in men | What is NGU?
Frequently Asked Questions
Is chlamydial urethritis the same as chlamydia?
It’s chlamydia specifically affecting the urethra. Chlamydia can also infect the throat (pharyngeal) and rectum (rectal). Urethral infection is the most common site in men.
Can chlamydial urethritis clear on its own?
Not reliably. While some infections may eventually resolve, you remain infectious and at risk of complications the entire time. Antibiotic treatment is quick, effective, and essential.
Can I get chlamydial urethritis from oral sex?
Yes, but it’s less common than through vaginal or anal sex. Receiving oral sex from someone with throat chlamydia could potentially lead to urethral infection.
How do I know if it’s chlamydia or gonorrhoea?
You can’t tell from symptoms alone — both cause discharge and burning. A urine NAAT test checks for both simultaneously. Gonorrhoea tends to cause thicker, more profuse yellow-green discharge, but the overlap is significant. Always test rather than guess.
Related reading
- Abnormal Genital Discharge and Chlamydia
- Can Mycoplasma Genitalium Be Cured?
- Can You Get Chlamydia From Kissing?
- Can You Have Chlamydia and Test Negative?
- Chlamydia and Gay Men: What to Know
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
