Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (2022)

Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (1) X

  • What you feel(symptoms)
  • What you see(signs)
  • Odds of getting it
  • Testing
  • Testing algorithm
  • Treatments
  • Treatment algoritms
  • Gonorrhea vs. other conditions
  • Gonorrhea vs. chlamydia
  • Gonorrhea vs. bacterial vaginosis
  • Protecting
  • Myths

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 TypeEarliest testing timeIdeal Testing Time
Genital Swab2–7 days
Likely to detect
(no rate of accuracy)
2 weeks
(99% accuracy)
Rectal swab2–7 days
Likely to detect
(no rate of accuracy)
2 weeks
(99% accuracy)
Oral swab2–7 days
Likely to detect
(no rate of accuracy)
2 weeks
(99.4% accuracy)
Urine test2–7 days
Likely to detect
(no rate of accuracy)
2 weeks
(79% accuracy)

Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (2)

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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 Testing: Types, Accuracy, Timing, Needs & Analysis (3)

    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
    CharacteristicsSchedule
    Preventive testing for general populationSexually active females younger than 25 years of ageOnce a year
    People who had unprotected sex with a new partner2–3 weeks after unprotected sex
    People who have a gonorrhea- positive partner2–3 weeks after unprotected sex
    Testing for high-risk individualsPeople with multiple sex partnersOnce 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 areaFirst 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 Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (4)

    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 Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (5)

    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.

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    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.

    • Accuracy

    Urethral swab tests are more accurate than urine tests (99% vs. 79%).

    • Pain and Discomfort

    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? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (6)

    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.

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  • How Reliable and Accurate Are Gonorrhea Tests? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (7)

    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? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (8)

    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.

    Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (9)

    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? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (10)

    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.

    Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (11)

    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? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (12)

    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? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (13)

  • Where can I get tested for gonorrhea? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (14)

    It depends on the test type you choose.

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    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: Types, Accuracy, Timing, Needs & Analysis (15)

    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? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (16)

    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 Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (17)

    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? Gonorrhea Testing: Types, Accuracy, Timing, Needs & Analysis (18)

    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.

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    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

Select other section

FAQs

What is the most accurate test for gonorrhea? ›

Nucleic acid amplification tests (NAAT).

NAATs find the genetic material (DNA) of gonorrhea germs. These tests are very accurate. They can be done on urine samples or samples of body fluid from the area where the infection is suspected.

How accurate is gonorrhea testing? ›

For gonorrhea testing in women, the sensitivity and specificity were 79% and 99%, respectively, for urine samples compared to cervical samples. For gonorrhea testing in men, the sensitivity and specificity were 92% and 99%, respectively, for urine samples compared to urethral samples.

How do you read gonorrhea test results? ›

Gonorrhea test results are reported as positive or negative. A positive test result, sometimes called an abnormal result, indicates that you have an active gonorrhea infection that requires treatment. If your gonorrhea test result is positive, your sexual partner(s) should be tested and treated as well.

What is the gold standard for testing for gonorrhea? ›

As with chlamydia, NAATs are now considered the gold standard for diagnosing gonorrhea. The USPSTF found that testing for gonorrhea using NAATs had a sensitivity ranging from 90 to 100 percent and a specificity greater than 97 percent.

How long is gonorrhea test positive? ›

Gonorrhea. A doctor can test for gonorrhea with a urine sample. In some cases, they may also swab the urethra, anus, throat, or cervix to get a more reliable result. Most tests can detect the infection within 5 days to 2 weeks of exposure.

How long do gonorrhea tests take? ›

Gonorrhea. A urine test can be used to diagnose gonorrhea, but in some cases a genital swab may be used to collect a sample instead, as this can be more accurate. Results are usually available in 2-3 days.

Can gonorrhea test be false positive? ›

Even using a test with a specificity of 99 percent in a population at high risk for gonorrhea with a prevalence of 0.5 percent, two-thirds of positive screening tests would be expected to yield false-positive results. Harms of treatment include adverse drug-related effects.

How long does gonorrhea last after treatment? ›

It's sometimes possible to have an antibiotic tablet instead of an injection, if you prefer. If you have any symptoms of gonorrhoea, these will usually improve within a few days, although it may take up to 2 weeks for any pain in your pelvis or testicles to disappear completely.

Can a gonorrhea test be a false negative? ›

Summary. New diagnostic accuracy studies without major methodological limitations indicated that false-positive rates for gonorrhea and chlamydia were 3 percent or less, and false-negative rates ranged from 0 to 9 percent for gonorrhea and 0 to 14 percent for chlamydia across all NAATs and specimen types.

What does a negative gonorrhea test mean? ›

Negative/Normal: No gonorrhea bacteria were found. If you have certain symptoms, you may get additional STD tests to find out the cause. Positive/Abnormal: You are infected with the gonorrhea bacteria. You will be treated with antibiotics to cure the infection.

What happens if you test positive for gonorrhea? ›

If you test positive for gonorrhea, you should visit with your doctor or health care provider to discuss treatment of you and your sexual partners, as well as additional testing you may need. How Do I Find a Doctor? Many different types of health care providers can treat gonorrhea.

How long after gonorrhea treatment will you test negative? ›

At enrollment, patients were treated with single doses of ofloxacin, cefixime, or ceftriaxone. The median time to a negative urine LCR test result was 1 day for the men (mean, 1.6 ± 0.14 days) and 2 days for the women (mean, 1.7 ± 0.19 days).

What culture method is used for gonorrhea? ›

Specimens collected for gonorrhea culture should be obtained by using swabs with plastic or wire shafts and rayon, Dacron, or calcium alginate tips. Other swab material such as wood shafts and cotton tips might be inhibitory or toxic to the organism and should be avoided.

What is the best treatment for gonorrhea? ›

Adults with gonorrhea are treated with antibiotics. Due to emerging strains of drug-resistant Neisseria gonorrhoeae, the Centers for Disease Control and Prevention recommends that uncomplicated gonorrhea be treated with the antibiotic ceftriaxone — given as an injection — with oral azithromycin (Zithromax).

Is gonorrhea Gram positive or negative? ›

INTRODUCTION Gonorrhea, or infection with the gram-negative coccus Neisseria gonorrhoeae, is a major cause of morbidity among sexually-active individuals worldwide.

Can a urine test detect gonorrhea? ›

Testing for gonorrhea looks for the presence of Neisseria gonorrhoeae (gonorrhea bacteria) in your body. Urine samples can be used to test both men and women.

Can gonorrhea be tested by blood? ›

Most STIs can be tested by using urine or blood samples. Your doctor can order urine or blood tests to check for: gonorrhea. syphilis.

Can my partner test negative and I test positive for gonorrhea? ›

Yes, it is possible to contract a STI from someone who tested negative (for the STIs that they were tested for)… if (and only if!) they were positive for an STI that they weren't tested for.

How can you test for gonorrhea at home? ›

This at-home test by well-known STI testing brand Everlywell is the ultimate twofer: It tests for both chlamydia and gonorrhea using the same urine sample. Request this package online and you'll receive a kit with all the materials you need for sample collection in the mail.

How accurate is urine test for STD? ›

All three NAATs had greater than 95 percent specificity for both infections in urine, cervical, and urethral samples. Transcription-mediated amplification and strand displacement amplification had sensitivities between 80 and 93 percent.

What is gonorrhea caused from? ›

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse.

What are symptoms of gonorrhea in males? ›

In men, symptoms of gonorrhoea can include:
  • an unusual discharge from the tip of the penis, which may be white, yellow or green.
  • pain or a burning sensation when urinating.
  • inflammation (swelling) of the foreskin.
  • pain or tenderness in the testicles – this is rare.

How does throat gonorrhea spread? ›

Oral gonorrhea is spread through unprotected oral sex with an infected person. Close contact with infected genitals through the following circumstances can lead to oral gonorrhea: Giving oral sex to a partner with an infected penis. Giving oral sex to a partner with an infected vagina or urinary tract.

Does gonorrhea go away? ›

Symptoms of gonorrhea may come and go, but the disease will not go away on its own. Gonorrhea requires treatment, which involves a one-time antibiotic injection, as untreated gonorrhea can lead to serious complications.

Which injection can cure gonorrhea? ›

Gonorrhea can be cured with the right treatment. CDC recommends a single dose of 500 mg of intramuscular ceftriaxone.

What antibiotic kills gonorrhea? ›

Which antibiotic is best for gonorrhea? Per CDC recommendations, many doctors prescribe dual therapy, including an injection of ceftriaxone, plus a tablet of either azithromycin or a treatment course of doxycycline. The CDC recommends a single dose of azithromycin, which has been shown to be effective.

Can gonorrhea come back? ›

CAN I GET GONORRHEA AGAIN AFTER I'VE BEEN TREATED? Yes, you can get gonorrhea again. You can get it from an untreated partner or a new partner.

Can one partner have gonorrhea not other? ›

People get STDs by having sex with someone who has an STD. Once you are infected, you can infect someone else. Both gonorrhea and chlamydia often have no symptoms. Sometimes only one partner will have symptoms, even though both have the disease.

Is a negative STD test good? ›

Summary. STI tests are very accurate, but they are not perfect. The accuracy of a test is based on its sensitivity (ability to pick up positives) and specificity (ability to eliminate negatives). Tests that have lower sensitivity or specificity have a higher risk of false results.

Can I drink coffee before STD test? ›

Can I eat before an STD test? There's no need to fast before an STD test, even if it's a blood test, so no worries about eating or drinking anything beforehand. Can a urine test detect STDs? Urine tests are most commonly used to detect bacterial STDs, such as chlamydia and gonorrhea.

Can you still have gonorrhea after treatment? ›

Even if you finish your treatment and the gonorrhea is totally gone, it's possible to get infected with gonorrhea again. Gonorrhea isn't a one-time-only deal. So use condoms and get tested regularly.

How long can you have gonorrhea? ›

In males, symptoms usually appear two to seven days after infection but it can take as long as 30 days for symptoms to begin. Often, there are no symptoms for people infected with gonorrhea; 10 to 15 percent of men and about 80 percent of women may have no symptoms.

Who is affected by gonorrhea? ›

Gonorrhea can affect people of any age or gender, but it's particularly common among teens and young adults between the ages of 15 and 24. Untreated gonorrhea can lead to long-term health concerns and, in some cases, infertility.

Can gonorrhea be detected in 24 hours? ›

Gonorrhea may show up on tests as soon as 2 – 6 days after exposure. However, everyone is different, and it's common to not experience symptoms, so it is highly recommended to test after every potential exposure.

Does gonorrhea need test of cure? ›

A test-of-cure is unnecessary for persons with uncomplicated urogenital or rectal gonorrhea who are treated with any of the recommended or alternative regimens; however, for persons with pharyngeal gonorrhea, a test-of-cure is recommended, using culture or nucleic acid amplification tests 7–14 days after initial ...

Can you test negative for gonorrhea and still be a carrier? ›

Certain STIs will show up on a test within a couple of weeks of infection, while others will take much longer. This means if you test too early for certain STIs, the infection might not show up. In other words, it's possible to have an STI even if you tested negative the first time.

Can gonorrhea go undetected in tests? ›

Many people with gonorrhea don't know they have it. So they may spread it to others without knowing it. Men with gonorrhea may have some symptoms. But women often have no symptoms or mistake gonorrhea symptoms for a bladder or vaginal infection.

Can gonorrhea be detected in blood test? ›

Most STIs can be tested by using urine or blood samples. Your doctor can order urine or blood tests to check for: gonorrhea. syphilis.

Can gonorrhea test false negative? ›

Gonorrhea results are most accurate after seven days. While you can get tested earlier, there is a chance of a false negative if not enough bacteria or virus has accumulated from the infection to be detected on a test.

How long is gonorrhea test negative? ›

The median time to a negative urine LCR test result was 1 day for the men (mean, 1.6 ± 0.14 days) and 2 days for the women (mean, 1.7 ± 0.19 days).

Can my partner test negative and I test positive for gonorrhea? ›

Yes, it is possible to contract a STI from someone who tested negative (for the STIs that they were tested for)… if (and only if!) they were positive for an STI that they weren't tested for.

Can you get gonorrhea without cheating? ›

The main ways people get gonorrhea are from having vaginal sex, anal sex, or oral sex. You can also get gonorrhea by touching your eye if you have infected fluids on your hand. Gonorrhea can also be spread to a baby during birth if the mother has it.

What is the name of gonorrhea test? ›

Gonorrhea nucleic acid amplification (NAAT) testing: NAAT testing detects the genetic material (DNA) of the gonorrhea bacteria and is considered the optimal test for gonorrhea infection. This type of test can be performed on a urine sample or a swab taken from a site of potential infection.

How long does male gonorrhea last? ›

If you have any symptoms of gonorrhoea, these will usually improve within a few days, although it may take up to 2 weeks for any pain in your pelvis or testicles to disappear completely.

How long is gonorrhea treatment? ›

It takes 7 days for the medicine to work in your body and cure gonorrhea. If you have sex without a condom during the 7 days after taking the medicine, you could still pass the infection to your sex partners, even if you have no symptoms.

What is gonorrhea PCR? ›

The screening technique (PCR or NAAT) detects the bacteria's DNA or RNA (genetic material) after amplification. Results are generally positive 7 days after infection. Depending on the risk factors, gonorrhea testing can be done on a urine, genital, urethral, throat or anal sample.

What happens if you test positive for gonorrhea? ›

If you test positive for gonorrhea, you should visit with your doctor or health care provider to discuss treatment of you and your sexual partners, as well as additional testing you may need. How Do I Find a Doctor? Many different types of health care providers can treat gonorrhea.

What causes gonorrhea? ›

Gonorrhea is caused by the bacterium Neisseria gonorrhoeae. The gonorrhea bacteria are most often passed from one person to another during sexual contact, including oral, anal or vaginal intercourse.

How often are gonorrhea tests wrong? ›

Even using a test with a specificity of 99 percent in a population at high risk for gonorrhea with a prevalence of 0.5 percent, two-thirds of positive screening tests would be expected to yield false-positive results. Harms of treatment include adverse drug-related effects.

What are the chances of a false positive gonorrhea test? ›

Its specificity, or the rate at which it correctly identifies people as not having gonorrhea, is greater than 99 percent. "One must realize that any test with a specificity less than 100 percent will have the potential for false positive results," said Dr. Alan Katz, lead author of the study.

How accurate are STD tests? ›

Data from the CDC suggest that for both STIs, a false positive is incredibly rare (99 percent of the time tests that come back negative are accurate). And if you do have the STI, it'll pick it up more than 90 percent of the time.

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