[Question #10019] Swab vs Urine STD test

26 months ago

Hi doctors - I am back for what will hopefully be my last question. So my partner (female) had several std (chlamydia, gonorrhea, trick) urine tests done and all came back negative. However, I read that urine tests are not as accurate as vaginal swab tests. So my questions to you are;

1. Are std urine tests no good for females?

2. Should I encourage my partner to spend additional money to see a doctor for a vaginal swab test?

3. The last std urine test was done by her primary doctor 2 weeks ago. Was the doctor wrong by ordering a urine test as opposed to a vaginal swab?

H. Hunter Handsfield, MD

26 months ago

I'm sorry you felt the need to return yet again. This will be your last question on these events and your STD fears. Looking back at your three recent threads, you are seriously over worried and overthinking your STD risks, including over-searching online for perspectives almost designed to enhance your fears. Probably (I would guess) out of shame or anxiety over the sexual decisions you regret with other men. As previously discussed, those were zero risk events for any and all STDs, and your and your partner's sexual lifestyles otherwise suggests little or no risk on their own.

1) Urine tests are fine in women. On average, in women vaginal swabs detect a slightly higher proportion of chlamydia and gonorrhea infections than urine does. However, both detect at least 95% of infections, and both detect a few infections missed by the other. But as I recall, your partner has been tested more than once anyway.

2) No, she should not be tested again. You can be confident she doesn't have gonorrhea or chlamydia.

3) No, the doctor was entirely right to select urine as opposed to vaginal swab testing.

Really, do your best to stop obsessing about these issues. All is well. If you continue to worry, I would first suggest going back and reading this and your previous three threads; and if that doesn't settle things, consider professional counseling. It isn't normal to remain so fearful after the repeated, reasoned, science based advice you had had on this forum and perhaps from your own doctors as well.

Best wishes and stay safe.

HHH, MD

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26 months ago

Thank you doctor. I will try to put this past me now. My next questions are in regard to trich:

1. She also got several trich urine naat tests that came back negative. Are these results reliable or should she open for a vaginal swab naat test for trich? I ask because she has some white discharge that has smelled the last few days.

2. Could I have gotten trich from engaging in mutual masturbation with me men or is that std also not likely to be transmitted.

H. Hunter Handsfield, MD

26 months ago

1. Good question. I'm not aware of data on how well trichomonas NAAT works on urine vs vaginal swab. I've emailed an expert on the topic; I'll let you know. However, in the meantime, the most common cause of vaginal discharge with odor is bacterial vaginosis. Trich can do it, but BV discharge is white or gray, trichomonas usually colored (yellow, brown, etc). If these symptoms continue and she considers them abnormal or bothersome, she should see her doctor. BV is common in monogamous women; she doesn't need to know or say anything to her doctor about your risk-free events with other men. In the off chance she has trichomonas, she didn't catch it recently from you; but trich can be carried by women for years.

2. There is no possibility of trich by such exposures. Trich rarely if ever infects the oral cavity or rectum, hence rare (probably nonexistent) in men who have sex only with men. No male has ever been known to acquire trichomonas other than by vaginal sex with an infected female partner.

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H. Hunter Handsfield, MD

26 months ago

I've heard back from some colleagues expert in trichomoniasis. They agree that urine testing is equally sensitive as vaginal swab in detecting trich in infected women.---