[Question #10780] Chlamydia / gonorrhea testing
19 months ago
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Hi Doctors,
I know last time you asked not to ask repetitive or obvious questions. This time I am not asking about any exposure or risk assessment, but some questions on tenting methodology and guidelines on G/C, so hopefully these can be answered.
As previously stated, I can only find providers where STI testing is done via urethral swab. I really don't want to go over that process, but have also not experienced it. While talking to the labs staff they admitted they can do urine specimen, but would need doctor's prescription explicitly stating urine sample, as per their words, it is a suboptimal sample.
I am thinking on biting the bullet and try urethral, but would not rather do it if unnecessary.
Are urine samples indeed suboptimal and urethral preferred? If that were the case, why is it that in the US urine is standard practice? If not really a difference, would you recommend then to skip on the bad experience and go through the additional hoops to get a urine sample?
Finally, last time we had an interaction you mentioned 4-5 was good enough time for chlamydia, but other responses state a week, while others have said that 72hrs should be okay. What would you say is a good window for this test?
19 months ago
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Also, are there any risks that a bad technique, or too big of a cotton swab can cause any damage on the urethra/penis?
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Edward W. Hook M.D.
19 months ago
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Welcome back to the Forum for your 8th question in the past 18 months. You are correct that these questions are not repetitive but generic. They do suggest however, when taken in the context of your other questions that you are really worrying more about STIs than you need to be and, as Dr. Handsfield indicated, possibly over-testing.
As I suspect you can understand, there are no studies which have left persons known to be exposed to gonorrhea or chlamydia untreated in order to determine precisely how long it takes tests to become positive however, expert consensus is that if you have acquired either gonorrhea or chlamydia, tests would be positive 3-5 days after an exposure. In 40 years of STI-focused practice, I have never had a patient tested 3 or more days return following a negative test with a test that had become positive.
Currently available nucleic acid amplification tests are among the most sensitive testing in all of medicine. This extraordinary sensitivity results in the fact that while urine tests are often SLIGHTLY less sensitive than urethral swabs for detection of gonorrhea or chlamydia than swab tests but this difference is not statistically significant and for any individual urine testing is equally reliable and less uncomfortable than urethral swabs. In symptomatic persons there is no meaningful difference in test performance between urine and urethral swabs; for asymptomatic persons being screening for infection, on rare occasions a swab might pick up an infection missed by urine but this would be quite unusual.
Taking a urethral swab may be uncomfortable but when taken by a trained professional is not associated with complications. EWH.
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