Gonorrhea testing: types, accuracy, timing, and necessity
In this section we will talk about the testing necessary to establish or rule out a gonorrhea diagnosis.
Unlike other infections, gonorrhea, if contracted, stays in the point of initial contact. So, testing one area does not rule out the possibility of having gonorrhea in another area. All susceptible areas that could have come into contact with the infection during sex should be tested.
This section will summarize different gonorrhea tests, timing, and their accuracy. As in previous sections, tables with statistics will be followed by FAQs from real patients and common scenarios.
So, let’s move on!
Timing and Accuracy of Different Gonorrhea Tests
This table summarizes the information on timing (i.e., how soon the test can be done) and accuracy of gonorrhea tests of different anatomic areas for asymptomatic people.
Note: If you have symptoms, you can be tested at any time, regardless of how much time has passed since the initial contact.
The table is separated into three columns:
- Test Type—which kind of test
- Earliest Testing Time—the earliest time after the exposure when the test for that area can be performed
- Ideal Testing Time—the ideal time after exposure when the test for that area can be performed
Note: The numbers mentioned below are the average estimates of test reliability and may vary from case to case. (Different factors such as the testing technique may affect the actual results.)
| Test Type | Earliest testing time | Ideal Testing Time |
|---|
| Genital Swab | 2–7 days
Likely to detect
(no rate of accuracy) | 2 weeks
(99% accuracy) |
| Rectal swab | 2–7 days
Likely to detect
(no rate of accuracy) | 2 weeks
(99% accuracy) |
| Oral swab | 2–7 days
Likely to detect
(no rate of accuracy) | 2 weeks
(99.4% accuracy) |
| Urine test | 2–7 days
Likely to detect
(no rate of accuracy) | 2 weeks
(79% accuracy) |
Frequently Asked Questions
Here Dr. Slava Fuzayloff (a.k.a. Dr. F) answers real patients’ questions, grouped by topic. Dr. F has been an STD doctor in New York City for more than two decades.
Gonorrhea Testing: Who Needs It—Asymptomatic vs. Symptomatic 
Gonorrhea is an extremely prevalent condition that often goes without any noticeable signs or symptoms. This is why gonorrhea testing is recommended for both symptomatic and asymptomatic people who are falling into one of the following categories:
| Asymptomatic people |
|---|
| Characteristics | Schedule |
|---|
| Preventive testing for general population | Sexually active females younger than 25 years of age | Once a year |
| People who had unprotected sex with a new partner | 2–3 weeks after unprotected sex |
| People who have a gonorrhea- positive partner | 2–3 weeks after unprotected sex |
|
| Testing for high-risk individuals | People with multiple sex partners | Once a year |
| Sexually active MSM (male sex with male) | Once a year (for those who use drugs and/or have multiple partners, screening is recommended once every 3–6 months.) |
| Pregnant women with high-risk behavior (e.g., having a partner with an STD, having multiple partners, etc.) or who live in a gonorrhea-prevalent area | First trimester, also during the last trimester for those who proceed to practice high-risk behavior or live in a gonorrhea-prevalent area |
Gonorrhea Test Interpretation: Positive, Negative, and Equivocal
We will talk about three different case scenarios for gonorrhea test results and what they mean:
1. Positive
If the gonorrhea test is positive, you are considered positive and need to be treated, notify your partner, and get retested in three weeks after you begin to have no symptoms.
2. Negative
If the gonorrhea test is negative, you may not have gonorrhea. But, two things need to be considered:
- Timing of the test —if enough time passed after the sexual encounter for the test to be most accurate. Two to three weeks after exposure is the ideal time to get tested.
- Overall accuracy of that particular test performed—79% accuracy for urine vs. 99% accuracy for the swab.
3. Equivocal/inconclusive
If the gonorrhea test is equivocal, this means the results are not conclusive and the test needs to be repeated.
For all inconclusive tests:
- The ideal test (i.e., swab) needs to be performed
- After the right incubation period (2–3 weeks)
- Alternative test and same test that showed inconclusive report should be performed.
Gonorrhea Urethral Swab vs. Urine Test: Accuracy and Invasiveness—How to Choose the One You Need
A gonorrhea test is the point-of-contact test. Here we are comparing the swab and. urine tests for urethral gonorrhea only. For oral and rectal areas, only the swab test can be done.
Both swabs and urinalyses are widely used in the diagnosis of urethral gonorrhea. Below we summarize the key points to consider when choosing between test types.
Urethral swab tests are more accurate than urine tests (99% vs. 79%).
Urine test is simpler to perform because it is non-invasive—no pain.
Swab test
- Male: mildly painful test and privacy issue (need to expose the genitals)
- Female: privacy issue (need to expose genitals)
How to Choose the One You Need
Screening Only
- Male: urine
- Female: urine or swab
Gonorrhea-Positive Partner
- Male: urine or swab
- Female: swab and urine
If the swab test is more accurate than the urine test, why is the urine test still being offered?
Though swab tests are more accurate in the detection of genital gonorrhea (especially for females), sometimes people choose to take the urine test for the following reasons:
1. Non-invasiveness
Urine gonorrhea test is non-invasive and are totally free of any discomfort, whereas swab tests may cause mild pain in males and vaginal bleeding in females during the procedure.
2. Cost
Swab tests are more expensive than urine tests.
3. Availability and Ease
Urine tests are easier to perform and are more widely available than swab tests. You can get a urine test at almost any health facility.
How Reliable and Accurate Are Gonorrhea Tests?
The gonorrhea tests are considered reliable in terms of establishing a diagnosis. The reliability (i.e., accuracy) of the gonorrhea test is based on three main factors:
- 1. Test type performed—urine vs. swab
- 2. Time that has passed from the possible gonorrhea exposure—two to three weeks after exposure is ideal.
- 3. Pre-test preparation—avoid douching or using vaginal creams for 24 hours; avoid urinating for two hours in the case of urine test.
- 4. Test technique—results should be properly collected.
If all above points are followed, the urine and swab tests will have 79% and 99% accuracy, respectively.
How is the swab test done in females?
A doctor administers the test. It takes two minutes. A sample of fluid from the vagina and/or cervix will be collected by a sterile, thin cotton swab (see illustratiom below). The procedure might cause very mild discomfort. If the area is infected and the mucosa is fragile, swabbing might cause minor spotting afterwards (but this is rare). Remember: You should not use vaginal creams and/or practice douching 24 hours before testing.
Image source:
Chlamydia / N. Gonorrhoeae RNA, TMA - Unisex Collection | Diagnostic Laboratory of Oklahoma. https://www.dlolab.com/chlamydia-n-gonorrhoeae-rna-tma-unisex-collection.
How is the swab test done in males?
A doctor administers the test. It takes about 15–30 seconds. The thin, sterile cotton swab is inserted into the tip of the penis—¾ of the inch into the urethra—to collect the urethral fluid. Mild discomfort at the time of the procedure is possible.
Image source:
Chlamydia / N. Gonorrhoeae RNA, TMA - Unisex Collection | Diagnostic Laboratory of Oklahoma. https://www.dlolab.com/chlamydia-n-gonorrhoeae-rna-tma-unisex-collection.
What is the name for the swab test?
The chlamydia swab test has several names that are used interchangeably by different labs:
- Chlamydia NAAT test
- Chlamydia Nucleic Acid Amplification Test
- Chlamydia DNA probe test
- CT TMA
- CT Aptima
What is the urine test called?
The chlamydia urine test has a couple of interchangeable names:
Where can I get tested for gonorrhea?
It depends on the test type you choose.
Urine Test
- Can be done in any health facility, including urgent care, PCP, urology, GYN, STD clinics, etc.
Swab Test
- Not every health facility carries swab kits or has a healthcare professional who can perform the test. Swab tests are mostly performed at STD clinics, Planned Parenthood offices, city sexual health clinics , urology, and GYN clinics.
Gonorrhea Testing Health Insurance Coverage
Gonorrhea testing is considered medically necessary and is usually covered by health insurance. It can be done as many times as you need.
If you want to be sure, call your insurance company and inquire about:
- The preferred lab for your plan
- If your copay, coinsurance, or deductible applies toward testing
Oral and Rectal Swabs—Who Should Get Tested?
Oral (i.e., pharyngeal) gonorrhea is a common condition that affects up to 3% of sexually active individuals. According to the international guidelines, the pharyngeal (i.e., oral) swab test for gonorrhea is recommended to all individuals who:
- Have oral gonorrhea signs and symptoms (e.g., swollen, red pharynx, fever, pus-filled patches on the throat, etc.)
- Have high-risk behavior (e.g., oral sex, multiple partners, etc.)
According to the CDC, the oral gonorrhea screening test is recommended to:
- MSM who have practiced oral sex in the preceding year. Moreover, a screening test every three to six months is recommended to MSMs who use methamphetamine, have multiple sex partners, and/or have a partner(s) who are engaged in such activities.
- People with HIV
Remember: The gonococcal bacteria are stored locally (i.e., in mucosal cells of the area of exposure), so genital swab, urine, or blood tests cannot identify oral gonorrhea.
Genital Gonorrhea Retesting after Treatment
No retesting after the treatment is recommended:
- The patients with genital gonorrhea who have completed the prescribed treatment and have no symptoms of infection do not need to get another test.
If you choose to get retested after the treatment:
- The type of test that diagnosed you with gonorrhea initially can be done to confirm recovery. The test can be performed 14 days after treatment. It is your choice to get retested for genital gonorrhea recovery.
In general, people who tested positive for gonorrhea need to be tested more frequently since they are considered to be at higher risk. Retesting is advised every three months.
What type of tests should I do for resistant cases?
The agar dilution test is considered a gold standard for resistant gonorrhea cases. This test has more than 95% specificity and 99% sensitivity. It should tell you which antibiotic is best for the gonorrhea you have.
Strict protocol should be followed before considering resistant gonorrhea:
1. Get the gold-standard treatment shot of ceftriaxone (250 mg.) and 1 mg. of azithromycin (or equivalent medication if allergic to the above). 0.1%–0.3% of gonorrhea cases are resistant to the gold-standard treatment.
2. Wait one week after treatment before being sexually active again.
3. Avoid sex until your partner is tested and treated. Your partner should be tested two to three weeks after the last exposure
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