Urine Testing for Sexually Transmitted Diseases

Urine testing for STDs is becoming increasingly available. These days, several STDs can be detected using urine testing. Urine chlamydia tests and gonorrhea tests are a lot more pleasant than urethral or cervical swabs and are quickly becoming standard practice. It may be more difficult to find urine testing for other STDs, such as trichomoniasis or HPV.

It used to be that STD testing, particularly for bacterial STDs, was very uncomfortable. Men who thought they might have a bacterial STD like chlamydia or gonorrhea got tested by having a swab inserted into their urethra. Women had to undergo a pelvic exam. During that exam, a cervical swab would be taken and tested for bacteria.

The fact that STD testing was uncomfortable and invasive made it less likely that people would undergo regular STD screening. That probably contributed to what is sometimes known as the hidden epidemic of asymptomatic STDs. Because many STDs have no symptoms, the only way to detect them is through testing. When people aren't tested regularly, they can spread STDs to their partners without even knowing it. Urine testing, as opposed to swab testing, makes it easier for people to undergo STD testing as part of their regular medical care. (However, STD testing is still not a standard part of most annual exams.)

Urine testing is currently primarily used to detect bacterial STDs. Chlamydia and gonorrhea urine tests are widely available. Trichomoniasis urine tests are also available, but they are less common. 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 DNA 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. For most people, the thought of getting gonorrhea urine test or chlamydia urine test is a lot less intimidating than the thought of needing a physical exam.

Urine testing is completely safe. You will provide a urine sample, that you collect yourself, to the doctor. Then they will use special tests to identify whether it contains bacterial DNA. There are no contraindications for urine STD testing.

You do not need any special preparation for a urine STD test. However, before you are given any urine STD test, it is good to talk to your doctor about what STDs you are going to be tested for. You should discuss why the specific tests have been chosen. You may also want to ask for additional testing if you are at risk for other STDs that your doctor is not planning to test for. Finally, you should ask how long the results will take to come back and whether the doctor's office will call you if the results are negative. Some offices only call for positive test results.

When you have a urine STD test, it is usually during a regular appointment. You will be asked to pee into a sample collection cup or tube. That tube will be given to one of the medical staff. Your urine sample will then be sent out to a lab, or tested at the clinic. You can leave as soon as you are done giving the sample or when your appointment is finished.

Urine STD test results are usually available in 5-7 days. However, that will depend on where your urine sample was sent for testing. A positive test result means that you are infected with that STD and should be treated. A negative test means there was no evidence that you were infected with that STD at the time of the test.

Even with a negative test, it is important to undergo regular STD testing if you are sexually active and not in a mutually monogamous relationship. Depending on your number of sexual partners you may want to be screened once a year, or more often. Urine STD testing is not a one-time thing. You could get infected in your next sexual encounter.

Some people still question whether urine testing is as effective at detecting bacterial STDs like 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. In contrast, urine passes through the most common site of infection (the penile urethra), in men.

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 to a pelvic exam if urine testing isn't available.

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.

Chlamydia and gonorrhea are the two most common notifiable diseases in the United States. In 2017, over 1.7 million cases of chlamydia were reported to the CDC in addition to more than 550,000 cases of gonorrhea. 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.

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.

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. People who only engage in vaginal intercourse can get by with urine testing alone for gonorrhea and chlamydia. 

Currently, only gonorrhea and chlamydia are commonly tested for using urine samples. However, there are other STDs that can be tested for this way. Trichomoniasis urine tests are becoming more widely available. Like gonorrhea and chlamydia, trichomoniasis is a very common, curable STD. As such, it makes a lot of sense for doctors to test for it at the same time. Urine testing is one option for doing that. As with chlamydia and gonorrhea, some research suggests that urine testing may not be as effective as doing similar tests on a vaginal swab. 

HPV is another STD that can be detected using urine tests. As with trichomoniasis, urine tests for HPV are not yet widely available. However, research suggests that testing first-void urine is just as effective as testing vaginal smears. That said, when compared to Pap smears, urine HPV tests have the same problem as other HPV tests—many HPV infections go away on their own. Therefore, it may be more useful to know if there are problematic cervical changes rather than whether someone has HPV. You can only do that with a Pap smear or VIA test.

There are no commercial urine tests available for syphilis or herpes. While the FDA did approve an HIV urine test in the 1990s, it is rarely if ever used. Oral and blood samples are far more likely to be used for HIV testing. There is even a home test for HIV that uses saliva samples.

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

For most people, it's far more important to get tested for STDs than to worry about getting the best STD test. Getting tested on a urine sample 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. Therefore, if urine STD tests or self-swabs are less scary for you, ask for them. You can even call your doctor's office before your appointment to make certain that urine tests are available. If they aren't, you can always choose to get tested somewhere else.

It can be scary wondering if you have an STD. However, most people discover that it's better to know. That's particularly true for bacterial STDs, which are treatable with a simple course of antibiotics. It may be stressful to learn about an infection. Still, you'll feel better once you know it's gone.