Urine Testing for Sexually Transmitted Diseases

November 14, 2018

Urine testing for STDs is becoming increasingly available. That is a good thing. It was that STD testing, particularly for bacterial STDs, was quite uncomfortable. Men who believed they might have a bacterial STD such as chlamydia or gonorrhea obtained analyzed with a swab inserted in their urethra. Ladies had to undergo a pelvic exam. During that exam, a cervical swab would be taken and tested for bacteria.

Now, several STDs can be discovered using urine screening. Urine chlamydia tests and gonorrhea tests are far more agreeable than urethral or cervical swabs. In some areas STD urine testing could be somewhat difficult to discover. However, it’s getting easier and easier every year. That’s especially true for gonorrhea and chlamydia, in which urine tests are fast becoming standard practice.

Urine Testing for Bacterial STDs

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

These days, bacterial DNA testing is regarded as a better option. It works differently than bacterial culture. Instead of attempting to develop bacteria, these tests simply search for bacterial DNA. This can be done with a process called LCR (ligase chain reaction) or together with other DNA amplification methods.

These types of testing are sensitive to very small amounts of bacterial DNA. Even better, they don’t require a live bacterial assault. As such, they can be run on urine samples, not just urethral or cervical swabs. For most people, the thought of getting gonorrhea urine evaluation or chlamydia urine test is a whole lot less intimidating than the thought of needing a physical exam.

Are Urine STD Tests As Good as Additional STD Tests?

Some people still question whether urine testing is as effective at detecting bacterial STDs such as chlamydia and gonorrhea. These questions typically focus on the effectiveness of these tests in girls. Why? The most frequent site of female infection (the cervix) is not on the pathway that urine travels out of the body.In comparison, urine moves through the most common site of infection (the penile urethra), in men. 

A 2015 research that analyzed 21 studies of their comparative effectiveness of using different Kinds of samples to detect chlamydia and gonorrhea discovered that:

  • For chlamydia testing in girls, the sensitivity and specificity were 87 percent and 99% for urine samples in contrast to cervical trials.
  • For chlamydia testing in men, the sensitivity and specificity were 88 percent and 99 percent for urine samples in contrast to urethral samples.
  • For gonorrhea testing in women, the sensitivity and specificity were 79 percent and 99 percent for urine samples in contrast to cervical samples.
  • For gonorrhea testing in men, the sensitivity and specificity have been 92 percent and 99% for urine samples in contrast to urethral samples.

By and large, these results are relatively consistent with studies.

Lately, self-collected vaginal swabs were closer in effectiveness to cervical swabs than urine testing. For some girls, those may be a more suitable alternative where urine testing is not available.

So yes, tests on urine samples detect fewer STDs than evaluations on vaginal swabs. However, science suggests that urine screening does a pretty good job of locating most infected individuals. That is excellent news for men and women that wish to get tested for gonorrhea and chlamydia at a less invasive manner.  But some other STD tests nevertheless do require either a physical examination or a blood flow.

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 over 400,000 cases of gonorrhea. Most infections with gonorrhea and chlamydia are asymptomatic. The simple fact that many individuals don’t have any symptoms implies that the only method to detect and treat these illnesses is through screening. 

In men, these diseases most commonly infect the urethra, and in women the cervix. But, it’s possible to find both of these diseases from the neck, in oral sex. Anal sex may also result in rectal chlamydia and rectal gonorrhea infections.

Unfortunately, neither rectal nor oral/throat diseases will be detected by urine testing. It is thus important to let your doctor know when you have unprotected anal or oral intercourse. Testing should be carried out individually for those sites. Presently, it’s recommended that men who have sex with guys experience urine, throat, and rectal screening annually. Other men and women who regularly have unprotected anal or oral intercourse should consider a similar screening regimen. People who only engage in vaginal intercourse can get with urine testing exclusively for gonorrhea and chlamydia. 

Other STD Urine Tests

Currently, just gonorrhea and chlamydia are commonly analyzed for using urine samples. But, there are several other STDs which can be analyzed for this way. Trichomoniasis urine tests are also becoming more widely available. Like gonorrhea and chlamydia, trichomoniasis is a very common, curable STD. Therefore, it makes plenty of sense for doctors to check for it at the same time. Urine testing is one alternative for doing this. Much like chlamydia and gonorrhea, some research indicates that urine testing may not be as powerful as performing similar tests on a vaginal swab. 

HPV is another STD that can be discovered using urine tests. As with trichomoniasis, urine tests for HPV aren’t yet widely available. However, research indicates that testing first-void urine is equally as successful as analyzing vaginal smears. That said, in comparison to Pap smears, urine HPV tests have the same difficulty as other HPV evaluations. Most HPV infections go away on their own. For that reason, it could be more useful to know whether there are problematic cervical changes instead of whether someone has HPV. You can simply do that with a Pap smear or VIA test. 

There are no commercial urine tests offered for syphilis or herpes.  Though the FDA did approve an HIV urine test in the 1990s, it’s seldom if ever used. Oral and blood samples are a lot more likely to be utilized for HIV testing. There is a home test for HIV that uses saliva samples. 

A Word From Verywell

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

For many people, it’s a lot more important to get tested for STDs than to worry about getting the very best STD test. Getting tested on a urine sample might not be quite as effective as getting tested employing a doctor collected swab. But, it’s much better than not having analyzed in any way. Therefore, if pee STD checks or self-swabs are somewhat less frightening for you, ask for them. You can even call your doctor’s office before your appointment to make certain that urine tests are readily available. If they aren’t, you could always decide to get tested elsewhere. 

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.