This study set out to determine the relationship between infection with Chlamydia trachomatis (Ct) and trachoma in a treatment naïve region of the Solomon Islands. It follows earlier surveys which indicated that whilst trachomatous inflammation—follicular (TF) was present at levels warranting intervention, the prevalence of trachomatous trichiasis (TT) was low. The results of the study indicated that despite a high prevalence of clinical signs of disease, the estimated prevalence of Ct infection was low; this, taken with the finding that the prevalence of the sight-threatening end stage of disease was also low, called the authors to question whether the costly community-wide trachoma interventions are appropriate in this setting. The use of molecular tools at the population level to guide trachoma policy is still under investigation; this study will contribute to the pool of data required to assess the utility of these tools.