Same sex behavior is not infrequent among women in the USA and despite widespread prevalence of chlamydial infections, few data are available that describe its prevalence among these sexual minority communities. Recent studies indicate that some women who have sex with women (WSW) are at increased risk for STDs as a result of reported risk behaviors including sex with high-risk men. WSW should undergo routine age-based annual screening for Chlamydia trachomatis, as recommended by Centers for Disease Control and Prevention guidelines. Although incident HIV infection and a number of unsafe sex practices declined from the 1980s into the 1990s, men who report sex with men (MSM) continue to be at high risk for genitourinary and rectal chlamydial infection, and a high proportion of rectal infections are reported to occur in asymptomatic men. For MSM, providers are responsible for taking comprehensive sexual histories, conducting thorough physical exams and testing both urethral and rectal sites for chlamydia. Despite public health efforts, historically few STD clinics and gay men's health centers have offered rectal chlamydial screening for asymptomatic MSM. Implementation of nucleic acid amplification testing at rectal sites has been reported to be highly feasible. Providers should also be aware of risks for lymphogranuloma venereum infection and empirically initiate therapy in the appropriate clinical settings. © 2013 S. Karger AG, Basel.