That’s right, guys (and gals): we’re talking about those pesky sexually transmitted infections, gonorrhea and chlamydia. And you read that right. They can end up in your mouth and your butt.
So listen up, because this is about the only way to test properly for these two serious infections, and your previous provider may not have done it.
What is 3-site testing for gonorrhea and chlamydia?
When testing for these STDs, 3-site testing means checking for the infection in three separate places:
- Urethra, by collecting a urine sample. Site 1, and the only one most clinics test.
- Throat, by collecting a pharyngeal swab. Site 2.
- Anus, by collecting a rectal swab. Site 3.
Who should get 3-site testing?
Anyone who has oral and anal sex, of any gender, should test at all three sites. Testing only urine is a very heteronormative approach to managing your risk for STIs.
Gay and bisexual men in particular are at high risk for gonorrhea and chlamydia in the throat and anus, and should seek out a clinic that tests urine and swabs the throat and anus.
If I have these infections in my throat or anus, will a urine test find them?
No. If you’ve only tested urine for gonorrhea and chlamydia, the result says nothing about your throat or anus. If you have receptive anal or oral sex, you could be carrying either infection somewhere a urine test simply cannot see.
Is the risk significant if I skip 3-site testing?
Absolutely. If you have one (or both) of these infections in your urethra and get treated, that treatment will usually also clear the infection from your throat or anus. Good news, sure. But if the infection is only in your throat or anus and your urine test comes back negative, you walk out the door with an untreated infection living inside you, and you can pass it on.
The advice above held up. A few things are new:
- 3-site testing is now the official recommendation. The CDC advises sexually active gay and bisexual men to screen the throat and rectum, not just urine, at least once a year, and every 3 to 6 months with multiple partners or while on PrEP.
- Throat gonorrhea is the stubborn one. Treatment usually clears it, but the CDC now recommends a follow-up test of cure 7 to 14 days after treating gonorrhea in the throat.
- If you have a vagina, a swab beats urine. A self-collected vaginal swab is more accurate than a urine sample for chlamydia and gonorrhea.
- Doxy-PEP exists. A dose of doxycycline within 72 hours after sex cuts chlamydia and syphilis by roughly two-thirds (gonorrhea by less) for gay and bisexual men and transgender women who have had a bacterial STI in the past year. The CDC issued guidance in 2024. Ask us whether it fits you.
- Swabs take seconds and can be self-collected. There is no reason to skip them.
How do we test at The Doctor?
At The Doctor, we get to know you. We encourage patients to be honest, upfront, and out about everything from sexuality to mental health to sexual activity. We want to know you so we can help you stay healthy and active.
We run a no-judgement-zone kind of clinic, where you can be yourself, own your sexuality, and feel comfortable telling us how you have sex.
Based on that sexual history, we identify the STI testing you actually need, so we test the right sites and treat appropriately. A full sexual-health visit also covers HIV, syphilis, and hepatitis, and it’s the right moment to talk about PrEP. That’s the kind of approach that only comes from a practice that truly understands you and your life.
