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The Test Sample
What is being tested?
Gonorrhea is a common bacterial sexually transmitted disease (STD) that can cause serious complications if not detected and treated. Gonorrhea testing identifies if the bacteria Neisseria gonorrhoeae is the cause of a person's infection. Screening for, diagnosing, and treating gonorrhea is very important in preventing long-term complications and spread of the infection to others.
The Centers for Disease Control and Prevention (CDC) estimates that more than 820,000 people in the U.S. get new gonorrheal infections each year, but only about half of these infections get reported to the CDC. In the U.S., the highest reported rates of infection are among sexually active teenagers, young adults, and African Americans.
Gonorrhea is generally spread through sexual contact (oral, vaginal, or anal) with an infected partner. Risk factors include having multiple sex partners, coinfection or previous infection with another STD, and not using a condom correctly and consistently.
While some men with gonorrhea will notice symptoms, most women do not or will mistake gonorrhea symptoms for a bladder or other vaginal infection. For men, symptoms usually appear within 2 to 5 days of infection but can take up to 30 days. Women who experience symptoms usually do so within 10 days of infection. Signs and symptoms of gonorrhea are similar to and can be confused with those caused by another STD, chlamydia, so tests for these infections are often done at the same time. (For more, see "The Test" tab.)
Gonorrhea can usually be treated with a course of antibiotics. If not diagnosed and treated, gonorrhea can cause serious complications.
In women, untreated gonorrhea infections may lead to pelvic inflammatory disease (PID), which can develop from several days to several months after infection and cause complications such as:
- Long-term (chronic) pelvic pain
- An increased risk of tubal (ectopic) pregnancy, which can be fatal
Pregnant women who are infected may experience heavy bleeding before delivery and premature rupture of the membranes and/or have babies with low birth weights. They may pass the infection to their babies during childbirth.
In men, untreated gonorrhea can cause complications such as:
- Inflammation of the prostate gland
- Scarring of the urethra, possible narrowing or closing of the urethra
Untreated gonorrhea may also spread to the blood (septicemia) or joints, progressing to a serious condition called disseminated gonococcal infection (DGI). DGI symptoms include fever, multiple skin lesions, painful swelling of joints (gonococcal arthritis), infection of the inner lining of the heart, and inflammation of the membrane covering the brain and spinal cord (meningitis). Symptoms of DGI in infants born to infected mothers include those associated with arthritis, meningitis and sepsis, a severe, life-threatening condition.
DGI can be successfully treated using antibiotics similar to those used for treating uncomplicated gonorrhea. However, treatment-resistant gonorrhea is a growing threat. CDC guidelines currently recommend dual therapy with ceftriaxone and azithromycin to treat all uncomplicated gonococcal infections among adults and adolescents in the United States. If a person's symptoms do not resolve after treatment, a healthcare practitioner may need to perform additional "tests for cure" and susceptibility testing may be indicated.
Currently, there is no reliable technology that can determine antibiotic susceptibility without first culturing Neisseria gonorrhoeae. Laboratories must be able to perform essential culture techniques that grow the bacteria. However, the widespread use of the nucleic acid amplification test (NAAT) for gonorrhea has made this increasingly difficult.
How is the sample collected for testing?
For women, vaginal swabs may be used to collect a sample for genital gonorrhea testing. A healthcare practitioner may use a swab or small brush to collect a sample of cells or secretion from the vagina during a pelvic examination. Sometimes, a vaginal sample is collected by the woman who is undergoing testing (self-collection).
For men, a healthcare practitioner may use a swab to collect a sample from the urethra, the tube within the penis that allows urine to flow from the bladder.
Urine samples can be used to test both men and women. As you begin to urinate, collect the initial portion of your urine stream (first-catch) in a container provided by the healthcare practitioner or laboratory.
Sometimes, a healthcare practitioner may use a swab or brush to collect a sample of cells or secretion from other areas that may be infected, such as the rectum or throat.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
Tell the healthcare practitioner about any use of antibiotics or, if you are a woman, douches or vaginal creams. You may be asked to avoid using these within 24 hours before testing vaginal samples since they may affect test results. Menstruation will not affect results. You may be instructed to wait one to two hours after you last urinated before collecting the urine sample. Follow any instructions you are given.