Table 2 Opposing views and arguments on the current testing and treatment strategies in chlamydia (CT) control

1. Urogenital testing

Widely implement testing in asymptomatic key populations/communities

Reduce testing of asymptomatic women and MSM

1.1. In women, urogenital CT is prevalent, easily transmitted, and may cause complications

1.3. Test implementation in ‘real-life’ does not achieve the desired benefits (of reducing prevalence and avoiding complications)

1.2.With resources available, CT is easy to test

1.4.Testing may also bring harm

2. Extragenital testing

Test more to reveal missed extragenital infections

Reduce testing of asymptomatic CT with limited ‘relevance’

2.1. CT can occur at the pharyngeal and rectal sites in women and MSM

2.3. Rectal CT might not always reflect a ‘true’ infection in women

2.2. Rectal CT may comprise a ‘hidden’ reservoir of transmissible infections in women and MSM, and increase the risk for HIV acquisition and transmission in MSM

2.4. Clinical impact of pharyngeal or rectal (non-LGV) CT may be limited

3. Treatment

Use azithromycin

Use doxycycline

3.1. Azithromycin is easy to use, safe, and widely applicable

3.3. The risk of azithromycin treatment failure is high in rectal CT

3.2. Azithromycin is effective in curing urogenital and pharyngeal CT

3.4. Treatment, especially azithromycin, can cause AMR