Background: Recurrent urinary tract infections (UTIs) with negative urine cultures and nitrite-negative dipstick results represent a frequent diagnostic challenge in clinical practice. One often overlooked cause is infection with Chlamydia trachomatis (C. trachomatis). Main Findings: C. trachomatis infection is predominantly oligo- or asymptomatic and therefore remains undetected in a large proportion of affected individuals. In women, chronic urethritis caused by C. trachomatis may clinically mimic recurrent UTIs, characterized by leukocyturia in the absence of bacterial growth in standard urine culture. Similar findings are observed in men with recurrent non-gonococcal urethritis. Due to its obligate intracellular life cycle, C. trachomatis cannot be detected by routine urine culture and requires nucleic acid amplification testing (NAAT). Clinical Implications: In young women with recurrent nitrite-negative lower urinary tract symptoms and negative urine cultures, sexually transmitted infections, particularly C. Trachomatis, should be actively considered. Testing should not be delayed until symptoms occur but should be performed after sexual risk exposure to prevent further transmission and long-term sequelae. Conclusion: Targeted screening, consistent patient education, and interdisciplinary awareness are essential to improve diagnosis and management of C. trachomatis–associated urinary symptoms.