How do I order a urine test for gonorrhea?

How to Order a Urine Test for Gonorrhea

To order a urine test for gonorrhea, collect a first-void urine specimen and request a nucleic acid amplification test (NAAT), which is the gold standard diagnostic method with high sensitivity and specificity for detecting Neisseria gonorrhoeae. 1, 2

Specimen Collection Process

For First-Void Urine Sample:

• Instruct the patient not to urinate for at least 1 hour before collection
• Collect the first 20-30 mL of urine (the "first-void")
• Use appropriate sterile collection containers
• Label the specimen with patient information and test request

Alternative Specimen Options:

• For females: Vaginal swabs (self-collected or clinician-collected) are actually preferred over urine, offering equal or superior sensitivity 2
• For males: First-void urine or urethral swab (if discharge is present) 1
• For extragenital testing: Pharyngeal and rectal swabs should be collected based on sexual history 2

Test Selection

• Request specifically: Nucleic acid amplification test (NAAT) for Neisseria gonorrhoeae
• Consider adding Chlamydia trachomatis testing simultaneously, as co-infection is common 1
• Most laboratories use multiplex NAATs that detect both pathogens

Important Considerations

• NAATs have largely replaced culture methods due to superior sensitivity (>95%) and specificity (>99%) 1
• NAATs can be performed on non-invasive specimens like urine, making them ideal for screening asymptomatic individuals 3
• When ordering tests, specify if the patient is symptomatic, as this may affect test interpretation
• Consider testing for other STIs including syphilis and HIV 1

Special Populations

• For children or in cases with legal implications, culture remains the preferred method as it allows for antimicrobial susceptibility testing 1
• For pregnant women, follow standard testing protocols but ensure appropriate treatment if positive

Common Pitfalls to Avoid

• Don't rely on Gram stain for diagnosis in asymptomatic patients or women, as sensitivity is too low 1
• Don't forget to test extragenital sites (pharynx, rectum) in patients reporting oral or anal sex 2
• Don't use point-of-care rapid tests for screening as they have unacceptably low sensitivity 2
• Don't forget to arrange for appropriate treatment and partner notification if the test is positive

By following these guidelines, you can effectively order and collect specimens for gonorrhea testing, ensuring accurate diagnosis and appropriate treatment of this common sexually transmitted infection.