Urine Testing for Gonorrhea and Chlamydia

Less Invasive Testing for STDs

Urine and blood samples
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In the bad old days, testing for bacterial STDs was very uncomfortable. Men who thought they might have chlamydia or gonorrhea got tested by having a swab inserted into their urethra. Women had to undergo a pelvic exam.

Fortunately, thanks to technology, that's no longer true. These days, both of these STDs can be detected via urine testing. Urine chlamydia tests and gonorrhea tests are a lot more pleasant than urethral swabs.

In some places urine testing can be a bit more difficult to find. However, it's getting easier and easier every year. 

The Shift Towards Urine Testing

The gold standard for diagnosing bacterial STDs, such as chlamydia and gonorrhea, used to be bacterial culture. That involved attempting to grow bacteria out of samples that were taken directly from the cervix or urethra.

These days, bacterial testing is considered a better option. It works differently than bacterial culture. Instead of trying to grow bacteria, these tests just look for bacterial DNA. This can be done using a process called LCR (ligase chain reaction) or with other DNA amplification techniques.

These types of testing are sensitive to even very small amounts of bacterial DNA. Even better, they do not require a live bacterial sample. As such, they can be run on urine samples, not just urethral or cervical swabs.

Is Urine Testing Effective?

Some people still question whether urine testing is as effective at detecting chlamydia and gonorrhea.

These questions usually focus on the efficacy of the tests in women. Why? The most common site of female infection (the cervix) is not on the pathway that urine travels out of the body.

However, worries about urine testing efficacy seem to be unfounded. These tests may not be quite as good as swabs, but they're less likely to be rejected and they have become quite widely used.

The science suggests that urine testing does a pretty good job of finding most infected individuals. That is great news for people who want to be tested for gonorrhea and chlamydia in a less invasive way. However, some other STD tests still do require either a physical examination or a blood draw.

Research Findings

A 2015 study that examined 21 studies of the relative effectiveness of using different types of samples to detect chlamydia and gonorrhea found that:

  • For chlamydia testing in women, the sensitivity and specificity were 87 percent and 99 percent for urine samples compared to cervical samples.
  • For chlamydia testing in men, the sensitivity and specificity were 88 percent and 99 percent for urine samples compared to urethral samples.
  • For gonorrhea testing in women, the sensitivity and specificity were 79 percent and 99 percent for urine samples compared to cervical samples.
  • For gonorrhea testing in men, the sensitivity and specificity were 92 percent and 99 percent for urine samples compared to urethral samples.

By and large, these results are relatively consistent across studies. Interestingly, self-collected vaginal swabs were closer in effectiveness to cervical swabs than urine testing.

For some women, those may be a more acceptable alternative where urine testing isn't available.

To collect this type of sample, a woman just swirls a swab, like a large q-tip, in her vagina. Then the swab is tested using the same techniques as are used to test urine. This is a very effective way of testing.

Understanding and Preventing Gonorrhea and Chlamydia

Chlamydia and gonorrhea are the two most common notifiable diseases in the United States. In 2015, over 1.5 million cases of chlamydia were reported to the CDC in addition to almost 400,000 cases of gonorrhea.

In men, these diseases most commonly infect the urethra, and in women the cervix.

However, it is possible to get both of these diseases in the throat, from oral sex. Anal sex can also lead to rectal chlamydia and rectal gonorrhea infections.

Unfortunately, neither rectal nor oral/throat infections will be detected by urine testing. It is therefore important to let your doctor know if you have unprotected oral or anal sex. Testing should be done separately for those sites. Currently, it is recommended that men who have sex with men undergo urine, throat, and anal screening once a year. Other people who regularly have unprotected oral or anal sex should consider a similar screening regimen.

Most infections with gonorrhea and chlamydia are asymptomatic. The fact that many people have no symptoms means that the only way to detect and treat these infections is through screening. It is important to treat these infections, even if they're not causing discomfort. Left untreated, they can lead to infertility and other serious health consequences, particularly for women. Fortunately, both infections are relatively easily treated with antibiotics. Remember, it is important to take the medication as prescribed. Around the world, there is a growing problem with antibiotic resistant gonorrhea. Taking medication as prescribed can help keep that problem from becoming worse.

In addition to screening, prevention is a very important tool in the battle against gonorrhea and chlamydia. Both diseases can be prevented by reliably practicing safe sex. As these infections are spread by bodily fluids, barriers are very effective.  However, regular screening is still indicated for people who may be at risk. 

A Word From Verywell

For a long time, research suggested that cervical and urethral testing were slightly more effective than urine testing for chlamydia and gonorrhea. However, newer studies suggest that some urine tests may actually be better at picking up certain infections than old school bacterial cultures on swabs. Even when they're not superior, gonorrhea and chlamydia urine tests are more than good enough in most circumstances. Furthermore, the tests continue to get better with time.

The most important thing is to get tested. Therefore, if urine tests or self-swabs are less scary for you, ask for them. Getting tested on these types of samples may not be quite as efficient as getting tested using a doctor collected swab. However, it is much better than not getting tested at all.

Sources:

Chernesky M, Jang D, Gilchrist J, Hatchette T, Poirier A, Flandin JF, Smieja M, Ratnam S. Head-to-head comparison of second-generation nucleic acid amplification tests for detection of Chlamydia trachomatis and Neisseria gonorrhoeae on urine samples from female subjects and self-collected vaginal swabs. J Clin Microbiol. 2014 Jul;52(7):2305-10. doi: 10.1128/JCM.03552-13.

Falk L, Coble BI, Mjörnberg PA, Fredlund H. Sampling for Chlamydia trachomatis infection - a comparison of vaginal, first-catch urine, combined vaginal and first-catch urine and endocervical sampling. Int J STD AIDS. 2010 Apr;21(4):283-7. doi: 10.1258/ijsa.2009.009440.

Lunny C, Taylor D, Hoang L, Wong T, Gilbert M, Lester R, Krajden M, Ogilvie G. Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis. PLoS One. 2015 Jul 13;10(7):e0132776. doi: 10.1371/journal.pone.0132776.

Marangoni A, Foschi C, Nardini P, D'Antuono A, Banzola N, Di Francesco A, Cevenini R. Evaluation of the new test VERSANT CT/GC DNA 1.0 assay for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae in urine specimens.  J Clin Lab Anal. 2012 Feb;26(2):70-2. doi: 10.1002/jcla.21485.

Situ SF, Ding CH, Nawi S, Johar A, Ramli R. Conventional versus molecular detection of Chlamydia trachomatis and Neisseria gonorrhoeae among males in a sexually transmitted infections clinic. Malays J Pathol. 2017 Apr;39(1):25-31.

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