Urine Testing for Gonorrhea and Chlamydia
Yes, patients can absolutely provide a urine sample for gonorrhea and chlamydia testing using nucleic acid amplification tests (NAATs), which are the gold standard diagnostic method with high sensitivity (86-100%) and specificity (>97%) for both infections. 1
Specimen Collection Options
For Women
- Vaginal swabs (self-collected or clinician-collected) are the preferred first-line specimen for NAATs, demonstrating the highest sensitivity (92%) and specificity (98%) for chlamydia detection 2, 3
- Urine specimens are an acceptable alternative with sensitivity of 87% and specificity of 99% when compared to clinician-collected cervical samples 2, 3
- The same specimen can test for both gonorrhea and chlamydia simultaneously 2, 1
For Men
- First-void urine is a recommended first-line specimen option for NAATs 1
- Urine samples demonstrate sensitivity of 88% and specificity of 99% for chlamydia, and sensitivity of 92% with specificity of 99% for gonorrhea when compared to urethral swabs 3
- Urethral swabs are an alternative option 1
Key Technical Considerations
NAATs are FDA-cleared for use on multiple specimen types, including male and female urine, as well as clinician-collected endocervical, vaginal, and male urethral specimens 2. The critical advantage is that urine testing with NAATs is at least as sensitive as testing with endocervical specimens, clinician- or self-collected vaginal specimens, or urethral specimens 2.
Additional Testing Sites for High-Risk Populations
For men who have sex with men (MSM), testing should include all three anatomic sites—urogenital, rectal, and oropharyngeal—based on reported sexual practices, as extragenital infections are frequently asymptomatic and would be missed with urogenital testing alone 1, 4.
Common Pitfalls to Avoid
- Overfilled urine specimens (>30mL) should still be submitted for testing rather than discarded, as infections can be detected even in improperly collected samples, and patients may not return for retesting (only 60% compliance) 5
- Do not rely on Gram stain for endocervical, pharyngeal, or rectal specimens, as they lack sufficient sensitivity 1
- Ensure patients understand proper first-void urine collection technique to maximize diagnostic accuracy 2, 1