Urine Testing for Sexually Transmitted Diseases

Less Invasive Testing for Gonorrhea, Chlamydia, and other STDs

Urine and blood samples
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Urine testing for STDs is becoming increasingly available. That's a good thing. 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. 

Now, several STDs can be detected using urine testing. Urine chlamydia tests and gonorrhea tests are a lot more pleasant than urethral or cervical swabs. In some places STD urine testing can be a bit difficult to find. However, it's getting easier and easier every year. That's particularly true for gonorrhea and chlamydia, where urine tests are quickly becoming standard practice.

Urine Testing for Bacterial STDs

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. 

Are Urine STD Tests As Good as Other STD Tests?

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 where urine testing isn't available.

So yes, tests on urine samples detect fewer STDs than tests on vaginal swabs. However, 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.

Limits of Urine Tests for Gonorrhea and Chlamydia

Chlamydia and gonorrhea are the two most common notifiable diseases in the United States. In 2016, over 1.5 million cases of chlamydia were reported to the CDC in addition to more than 400,000 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.

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

Other STD Urine Tests

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 also 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. 

A Word From Verywell

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. 

Coorevits L, Traen A, Bingé L, Van Dorpe J, Praet M, Boelens J, Padalko E. Identifying a consensus sample type to test for Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis and human papillomavirus. Clin Microbiol Infect. 2018 Mar 17. pii: S1198-743X(18)30223-4. doi: 10.1016/j.cmi.2018.03.013.

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.

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