The Test Sample
What is being tested?
The test is looking for presence of the bacterium Neisseria gonorrhoeae, which causes the sexually transmitted disease gonorrhea. The Centers for Disease Control and Prevention (CDC) estimates that more than 700,000 people in the U.S. get new gonorrheal infections each year, but only 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 transmitted through sexual contact (oral, vaginal, or anal) with an infected partner. An infected mother can pass the disease to her baby during childbirth. Symptoms in newborns include conjunctivitis and pneumonia, which usually develop 5 to 12 days after birth. Complications in infants include eye infections which, if left untreated, can cause blindness.
While many men with gonorrhea will experience 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.
Gonorrhea can usually be treated with a course of antibiotics. If left untreated, gonorrhea can cause complications in men, women, and infants. In men, untreated gonorrhea infections may lead to:
- Inflammation of the prostate gland
- Scarring of the urethra, possible narrowing or closing of the urethra
Untreated gonorrhea infections in women may lead to:
- Pelvic inflammatory disease (PID), which can develop from several days to several months after infection. If left untreated, PID can cause infertility.
- Chronic menstrual difficulties
- Inflammation of the lining of the uterus after childbirth
- Inflammation of the bladder
About 1% of men or women with gonorrhea may develop Disseminated Gonococcal Infection (DGI), resulting from spread of gonorrhea infection to sites other than genitals. 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 include those associated with arthritis, meningitis and sepsis, a bacterial infection of the blood. DGI can be successfully treated using antibiotics similar to those used for treating uncomplicated gonorrhea.
However, treatment-resistant gonorrhea is a growing threat. Currently, CDC guidelines recommend dual therapy with a cephalosporin antibiotic (ceftriaxone is preferred) and either azithromycin or doxycycline to treat all uncomplicated gonococcal infections among adults and adolescents in the United States. A new strain of gonorrhea is resistant to cephalosporins. Cephalosporin resistance poses threats to people infected with treatment-resistant gonorrhea. There may be times that a person's symptoms do not resolve after treatment. The doctor may need to perform additional "tests for cure" and susceptibility testing may be indicated.
Greater use of newer non-culture-based laboratory technology such as NAAT and other molecular tests makes it difficult for laboratories to perform essential gonorrhea culture techniques required for antibiotic susceptibility testing. No reliable technology currently allows for antibiotic susceptibility testing from non-culture specimens.
How is the sample collected for testing?
Many different kinds of samples may be used for testing, but not all laboratories can test every kind of sample. A health practitioner may use a swab to collect a sample of secretion or discharge from the infected area such as the urethra, penis, anus, throat, cervix or vagina. Many doctors will take a sample from more than one body site to increase the likelihood of finding the bacteria. Sometimes a vaginal sample may be collected with a swab by the woman who is undergoing testing (self-collection). A first-catch urine sample is collected in a container provided by the health practitioner or laboratory.
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 your health care provider about use of antibiotics or, if you are a woman, douches or vaginal creams within 24 hours before testing vaginal samples, as they may affect test 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.