Urine Testing for Gonorrhea and Chlamydia

Less Invasive Testing for STDs

Urine Specimen on Toilet
Nancy R. Cohen/Photodisc/Getty Images

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 now be detected via urine testing. Urine chlamydia tests and gonorrhea tests are a heck of 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 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. However, these days, urine testing is considered a better option. It works differently than bacterial culture. Instead of trying to grow bacteria, most urine testing  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.

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 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. These are the two most common curable STDs. However, some other STD tests still do require either a physical examination or a blood draw.

How comparable are swab testing and urine testing for gonorrhea and chlamydia?

A 2005 study that examined 29 studies of the relative effectiveness of urine testing compared to swab testing using three different amplification techniques (PCR, transcription-mediated amplification, and strand-displacement amplification) found that:

  • For chlamydia testing in women, the sensitivity and specificity were 80-90 percent and 98-99 percent for urine samples and 85-98 percent and 98-99 percent for cervical samples.
  • For chlamydia testing in men, the sensitivity and specificity were 84-93 percent and 93-99 percent for urine samples and 87-95 percent and 96-99 percent for urethral samples.
  • For gonorrhea testing in women, the sensitivity and specificity were 55-91 percent and 98-99 percent for urine samples and 94-99 percent and 99 percent for cervical samples.
  • For gonorrhea testing in men, the sensitivity and specificity were 90 percent and 99 percent for urine samples and 96 percent and 99 percent for urethral samples.

A 2010 study saw similar results for chlamydia testing in women. Urine tests were slightly less sensitive than vaginal or cervical swabs. However, some newer tests are reporting results of similar quality to other samples. 

A Word from Verywell

In general, research suggests that cervical and urethral testing are slightly more effective than urine testing for chlamydia and gonorrhea. However, gonorrhea and chlamydia urine tests were more than good enough in most circumstances. Furthermore, the tests have gotten better with time. Some urine tests report similar effectiveness to swab tests.

It is not always possible to find out which urine test your doctor's office is using and how good it is. However, if it's going to make a  difference in your willingness to test, you should probably feel pretty comfortable peeing in a cup. Doing so may not be quite as efficient as getting tested using a swab. It is much better than not getting tested at all. 


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