Background and Goal: Studies assessing the relationship of Chlamydia trachomatis serovars or genotypes to clinical manifestations of urogenital disease have produced contradictory results. Possible reasons for this include small sample sizes insufficient to reliably detect associations and failure to address potential confounding factors. Utilizing a large dataset and multivariate analysis to address confounding factors, we undertook this study of the relationship of chlamydial serovars to specific clinical manifestations of urogenital disease. Study Design: This was a cross-sectional study of 480 women and 700 heterosexual men with urogenital chlamydial infection attending a sexually transmitted diseases clinic from 1995 to 1999 and a literature review. Results: Women (89%) and men (86%) were infected predominately with serovars D, E, F, Ia, and J. After controlling for age and race, we found that women who reported abdominal pain and/or dyspareunia were more often infected with serovar F (P = 0.048). An association of specific clinical manifestations with serovars was not detected in men. Conclusion: We conclude that clinical manifestations of C trachomatis urogenital infection are not strongly influenced by the infecting serovar.