Symptomatic urethritis or cervicitis: samples before treatment and test of cure

• Sample before any antibiotic, ideally at least 2 hours after the last void. Empirical treatment does not wait for results.

Urethral sample (if discharge)

• Urethral sample: direct examination and gonococcal culture with susceptibility testingif neededUrethral discharge: direct examination and gonococcal culture of the discharge ^[2]. Any gonococcus detected by PCR should also lead to a culture with susceptibility testing being requested, without delaying treatment ^[3].

On first-catch urine (at least 1 hour after the last void)

• Multiplex NAAT (PCR) for Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium
• Chlamydia and gonococcus NAAT (PCR) on pharyngeal and anal samples (depending on practices)if neededOral or anal intercourse, and routinely in men who have sex with men with several partners (multisite screening) ^[4]; covered on explicit prescription ^[5].
• Urine dipstick on the 2nd stream (no discharge)if neededBurning without discharge: think of a urinary tract infection or a urological cause ^[2].
• Herpes simplex PCR on urethral swab (if severe dysuria, lymphadenopathy, meatitis or ulceration)if needednon-French guidelineIn the United Kingdom, the BASHH (2026) proposes considering it in the presence of these signs (grade 2C) ^[6]; in Australia, the ASHM considers it if tests are negative and symptoms persist ^[7]. The SFD does not mention it in urethritis ^[2], and the European recommendation thinks of it in persistent urethritis ^[8]. NABM coverage limited to atypical mucocutaneous involvement ^[5].

Laboratory tests (screening for other STIs)

• HIV serology
• Syphilis serology
• Hepatitis B serology (HBsAg, anti-HBs, anti-HBc), if status unknownif neededVaccination or immune status unknown: hepatitis B is among the STIs to test for ^[2,9].
• Hepatitis C serology (if risk factor)if needednon-French guidelineHepatitis C risk factor: the European guideline includes HCV in the work-up for other STIs offered after gonorrhoea ^[9].

Speculum sample (endocervix and vaginal fornices)

• Endocervical and vaginal sample: direct examination, gonococcal culture with susceptibility testing, yeasts, Trichomonas
• Multiplex NAAT (PCR) for Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium (vaginal or endocervical)
• Trichomonas vaginalis nucleic acid amplification test (if direct examination negative and symptoms persist)if neededIn the United States, the CDC (2021) asks for a more sensitive test when direct examination is negative in a symptomatic woman, its sensitivity being about 50% ^[11]; Australia does this PCR straight away ^[14], and the BASHH estimates the sensitivity of direct examination at 40-60% ^[15]. The SFD also cites this PCR ^[2], which has no NABM procedure ^[5].
• Chlamydia and gonococcus NAAT (PCR) on pharyngeal and anal samples (depending on practices)if neededOral or anal intercourse: the SFD recommends testing for gonococcus in the pharynx and anus in cervicitis ^[2]; covered on explicit prescription ^[5].
• hCG (serum or urine) if pelvic pain or late periodif neededAssociated pelvic pain (suspected upper genital tract infection): see the page “Acute pelvic pain in women”.

Laboratory tests (screening for other STIs)

• HIV serology
• Syphilis serology
• Hepatitis B serology (HBsAg, anti-HBs, anti-HBc), if status unknownif neededVaccination or immune status unknown: hepatitis B is among the STIs to test for ^[2,9].
• Hepatitis C serology (if risk factor)if needednon-French guidelineHepatitis C risk factor: the European guideline includes HCV in the work-up for other STIs offered after gonorrhoea ^[9].

Gonococcus: at least 14 days after the end of treatment

• Repeat gonococcus NAAT (PCR) (initially positive site)if neededOnly if the treatment was not ceftriaxone, if the ceftriaxone MIC exceeds 0.125 mg/L or if the infection was acquired in Asia-Pacific; unnecessary after ceftriaxone on a susceptible strain with a good course ^[3].

Persistent symptoms

• Urethral or endocervical sample: gonococcal culture with susceptibility testingif neededGonorrhoea whose symptoms persist 72 hours after the start of treatment, without untreated co-infection: suspected failure on a resistant strain, culture as soon as the antibiotic is stopped ^[3]. In women, female genital sample (same procedure as the vaginal sample).
• Mycoplasma genitalium singleplex NAAT (PCR) (more than 3 weeks after the end of treatment)if neededPersistent or recurrent urethritis or cervicitis, especially if M. genitalium has not been tested for; or follow-up test of an M. genitalium infection only if symptoms persist more than 3 weeks after the end of treatment ^[5,10].
• M. genitalium macrolide resistance (if PCR positive)if neededM. genitalium detected: documented treatment relies on testing for macrolide resistance mutations ^[10]; the procedure is done on the positive sample ^[5].
• Trichomonas vaginalis nucleic acid amplification test (if persistent urethritis in a man having sex with women)if neededThe BASHH (2026) proposes considering it if the parasite is common locally (at least 2% of symptomatic women) ^[6]; the CDC (2021) asks for it where it is widespread ^[11]; the ASHM considers it if tests are negative ^[7]. The SFD and the European recommendation also cite it, and the SFD attributes 1% of urethritis in France to the parasite ^[2,8]; it has no NABM procedure ^[5].

Chlamydia: 3 to 6 months after treatment

• Chlamydia NAAT (PCR) (screening for reinfection)if neededAfter a treated Chlamydia infection: repeat PCR at 3-6 months to screen for reinfection (grade B) ^[4].

Gonococcus: 3 to 6 months after treatment

• Gonococcus NAAT (PCR) (if sexual risk-taking continues)if neededTesting for asymptomatic reinfection is recommended between 3 and 6 months if risk-taking behaviour persists (HAS 2025, grade AE) ^[3]. In the United States, the CDC (2021) repeats the test 3 months after any treatment of gonorrhoea ^[11].