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Urine Tests May Miss More Than 400 000 STIs in the US Every Year Using vaginal swabs to test for sexually transmitted infections (STIs) picked up significantly more cases of Chlamydia trachomatis and Neisseria gonorrhoeae than using urine tests, according to a metaanalysis of 28 studies conducted from 1995 through 2021.Vaginal swabs were also more sensitive for Trichomonas vaginalis, although the difference between test types was not significant.Despite guidelines released in 2014 by the US Centers for Disease Control and Prevention in favor of vaginal swabs, most samples analyzed by public health laboratories continue to be urine.The researchers estimated that depending on urine rather than vaginal swab testing could result in more than 400 000 missed STI cases each year."[V]aginal sampling should be the initial choice offered to patients," the researchers wrote in the Annals of Family Medicine, with urine samples only collected from those for whom a vaginal sample is unacceptable.Implementation research is needed to change physicians' go-to tests, they noted.