What STIs are Tested by Urine

Sexually transmitted infections, or STIs, are infections that are primarily spread through sexual contact — and they’ve been on the rise in Canada for over a decade. They were formerly known as sexually transmitted diseases (STDs), but the term STIs have become more commonplace since they account for the fact that infections can be asymptomatic. 

STIs are caused by bacteria, viruses, or parasites. Since many sexually transmitted infections don’t cause symptoms, it’s important to get a routine STI testing panel if you’re sexually active — untreated STIs can lead to serious health problems.

STIs are tested using blood, urine, or a swab of cells or fluid from the infected area. In this blog, we take a closer look at how urine tests work and which STIs can be detected in urine — along with some helpful tips for giving a urine sample.

How do urine tests work?

Urine is commonly used to test for bacterial and parasitic infections. Urine tests are quick and simple, and they’re non-invasive — no needles or swabs necessary.

Your provider will send you to the washroom with a little plastic cup, and you’ll return it with a small urine sample, which will go to the lab. The most common urine test for STIs is a nucleic acid amplification test, or NAAT, which detects the DNA from the bacterium or parasite causing the infection. Urine test results are usually available within a few days. 

How reliable are urine tests?

Urine tests aren’t infallible. As with any medical test, there’s always a potential for a false negative or a false positive due to factors like the sensitivity and specificity of the test. Sensitivity is the probability of a laboratory test being positive if the patient has the disease in question. Specificity is the probability of a laboratory test being negative if the patient does not have the disease in question.

Urine tests for STIs generally have high sensitivity and specificity, making them highly reliable for screening purposes. Still, false results can occur due to contamination in the sample or testing too soon after sex, before the infection is detectable.

Whether you test positive or negative for an STI, your healthcare provider will likely recommend retesting in six to 12 weeks to look for resistant strains of gonorrhea or chlamydia. That way, if treatment didn’t cure the infection — or you took the urine test before the STI was detectable — you can still treat it early enough to avoid complications.

Common STIs detected through urine testing

Urine tests are used to detect chlamydia, gonorrhea, and trichomoniasis. They’re not effective for detecting syphilis or viral infections like genital herpes and HIV.

Chlamydia testing

Chlamydia is a highly contagious bacterial infection and the most commonly reported STI in Canada. Between 2011 and 2019, chlamydia rates increased by 26%.  

Chlamydia trachomatis, the bacterium that causes chlamydia, is easily detected in urine around two weeks after exposure. You can also get tested with a swab sample, such as during a routine pap smear. 

Chlamydia is easy to treat with antibiotics — but left untreated, it can cause serious health complications, including infertility, pelvic inflammatory diseases, and reactive arthritis. It can also spread from an infected pregnant person to their infant during birth.

Gonorrhea testing

Gonorrhea is one of the most commonly reported STIs in Canada, with rates nearly tripling from 2010 to 2019. A highly contagious bacterial infection, gonorrhea is currently treatable with antibiotics, but Canadian health officials warn that this infection is becoming increasingly antibiotic-resistant, which could lead to gonorrhea cases that can’t be cured. Left untreated, it can cause infertility, blood infections, pelvic inflammatory disease (PID), and other health issues.

Neisseria gonorrhoeae, the bacterium that causes gonorrhea, can take up to two weeks after sex to show up in urine.

Although urine tests are commonly used to diagnose gonorrhea, a healthcare provider may choose to test using a swab of fluid taken from the vagina, cervix, rectum, urethra, or throat — the latter is due to oral gonorrhea cases being caused by oral intercourse. Either way, test results usually come back within a few days. 

Trichomoniasis testing

Commonly called “trich,” this less-common STI is caused by a single-celled parasite called Trichomonas vaginalis. It most commonly affects women, who may experience symptoms including foul-smelling vaginal discharge, genital itching or burning, and pain during urination or sex. Men who contract trichomoniasis generally have no symptoms.

Although the incubation period of the Trichomonas vaginalis parasite isn’t known, it’s thought to range from three days to four weeks or longer.

Healthcare providers typically test for trich using a urine sample or a swab of fluids from the vagina or the urethra in the penis. Test results are typically available within a few days. 

Trich is treatable with antibiotics — but all sex partners need to be treated at the same time to prevent reinfection. Untreated trichomoniasis increases the risk of cervical or prostate cancer, and it can lead to premature birth or low birth weight if you’re pregnant.

Tips for collecting a quality urine sample

To ensure the most accurate test results possible, avoid using douches or creams for 24 hours beforehand, and don’t urinate for at least one hour before the test. Avoid drinking a lot of water before the test, which may dilute your urine. Ask your healthcare provider how much water you can drink before testing.

Urine tests for chlamydia, gonorrhea, and trichomoniasis are most accurate when they’re performed on a “first catch” sample, or the first five to 20 ml of urine that comes out. Fill the sample cup according to your healthcare provider’s instructions to avoid diluting or contaminating the urine. After you collect the sample, put the lid on the cup, wipe the outside of it with a paper towel, and wash your hands.

Catching a urine sample is fairly simple, but if you’ve never done it before, these tips will help:

• In the days before the test, pay attention to your urine stream so you’ll know where to position the sterile collection cup.
• Clean your genitals thoroughly with the wipes the provider gives you.
• If you’re having a hard time going, try turning on the water. 

What’s next?

After your STI test, avoid sex until you get the results. 

If you test positive for an STI, take the prescribed antibiotics until they’re gone, even if any symptoms you have improve. Avoid sexual activity during treatment and for a week afterwards. 

Some STIs, including chlamydia and gonorrhea, are reportable, which means that if you test positive, your healthcare provider is required to inform your local public health department. 

Although reporting is anonymous and confidential, a public health nurse will likely contact you to offer support and ask for the names of people you’ve had sex with recently. They’ll contact your partners to inform them they may have been exposed to an STI, but they won’t use your name. This is known as contact tracing, and it’s meant to help curb the spread of STIs. If you’d rather inform your sexual partner(s) yourself, the public health nurse can offer tips on how to have the conversation.

Whether you test positive or negative, make a plan to re-test according to your healthcare provider’s recommendation — usually in six to 12 weeks.

Scheduling an STI test

Regular STI testing is an important part of preventive health care for anyone who is sexually active. Yet, a 2018 survey found that 50% of Canadians have never been tested for an STI, citing factors like the fear of a positive result and a lack of a primary care provider. 

If you’re among those Canadians without a primary care provider or unsure where you go, Maple makes it easy to take control of your sexual health. Maple gives you access to Canadian-licensed doctors and nurse practitioners 24/7/365 within minutes over secure text, audio, or video call.

At their discretion, primary care providers on Maple can order STI tests,  prescribe treatments, and work with you to determine your risks and create a proactive plan for routine screenings of all kinds. All of your data is in your hands, and secure within the app. 

Understanding the importance of STI testing and how urine tests work is important for taking control of your sexual health. Regular testing not only protects your well-being but also helps prevent the spread of infections to others. By staying informed and proactive, you can contribute to a healthier community and ensure peace of mind. Remember, taking the time to get tested is a simple yet powerful way to safeguard your health and foster open, honest communication about sexual wellness.

The information presented here is for educational purposes and is not meant to replace the advice from your medical professional. Virtual care is not meant for medical emergencies. If you are experiencing an emergency like chest pain or difficulties breathing, for example, please call 911 or go to your nearest emergency room.