American Society for Microbiology, American Society for Clinical Laboratory Science and American Society for Clinical Pathology

View all recommendations from this society

November 7, 2022

Do not routinely send urine for Chlamydia trachomatis and Neisseria gonorrhoeae (CT/NG) testing from females if vaginal swab collection is possible.

Nucleic acid amplification testing (NAAT) for CT/NG is standard of care for testing adults and has largely replaced culture. Vaginal swabs are the preferred single specimen for screening and diagnosis of CT/NG by NAAT providing 5% to >10% increased sensitivity compared to urine for females; testing multiple specimens (vaginal, endocervical, and urine) can further increase sensitivity. When vaginal collections are not possible due to the setting, test or collection device shortages, or very strong patient preference, first-void urine can be considered as a non-invasive alternative.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

(1–2) The American Society for Microbiology’s (ASM) list was developed under the leadership of the ASM’s Clinical and Public Health Microbiology Committee. The subject matter experts who identified the list and formulated the recommendations are laboratory directors at academic, commercial and public health laboratories and test utilization experts across the fields of microbiology and laboratory medicine. They worked together to identify a list of diagnostic and management decisions that have resulted in misuse of laboratory studies and resources.

In this submission, two statements were written to address the most common clinical microbiology laboratory test misconceptions. They consist of diagnostic tests or treatments that are commonly ordered, expensive and have no evidence to illustrate its value and in some cases, may be potentially harmful to the patient. The recommendations, if instituted, would result in higher quality care, lower costs, and more effective use of our laboratory resources and personnel. The experts involved in the new 2022 recommendations are James Dunn, Laura Filkins, Omai Garner, Elizabeth Palavecino and Preeti Pancholi.How This List Was Created

(3–4) These ASCLS recommendations were developed under the leadership of ASCLS’s Choosing Wisely Committee and the ASCLS Board of Directors. The Committee examined numerous options based on evidence available. Subject matter experts from the ASCLS Scientific Assemblies reviewed, edited, and recommended approval of these recommendations, which were subsequently reviewed and approved by the ASCLS Board of Directors.How This List Was Created

(5) The American Society for Clinical Pathology (ASCP) recommendation was developed under the leadership of the ASCP Effective Test Utilization Steering Committee. This committee is chaired by an ASCP Past President and is comprised of subject matter and test utilization experts across the fields of pathology and laboratory medicine. The committee considered a list of possible recommendations compiled as the result of a survey administered to Society members serving on ASCP’s many commissions, committees and councils. In addition, an announcement was made to ASCP’s Advisory Board seeking suggestions for possible recommendations to promote member involvement. The laboratory tests targeted in our recommendations were selected because they are tests that are performed frequently; there is evidence that the test either offers no benefit or is harmful; use of the test is costly and it does not provide higher quality care; and eliminating it or changing to another test is within the control of the clinician. Implementation of these recommendations will result in higher quality care, lower costs and a more effective use of our laboratory resources and personnel.


Papp JR, Schachter J, Gaydos CA, Van Der Pol B. 2014. Recommendations for the laboratory-based detection of Chlamydia trachomatis and Neisseria gonorrhoeae – 2014. MMWR Recomm Reports 63:1–19.

Shafer MA, Moncada J, Boyer CB, Betsinger K, Flinn SD, Schachter J. 2003. Comparing first-void urine specimens, self-collected vaginal swabs, and endocervical specimens to detect Chlamydia trachomatis and Neisseria gonorrhoeae by a nucleic acid amplification test. J Clin Microbiol 41:4395–4399.

Van Der Pol B, Taylor SN, Liesenfeld O, Williams JA, Hook EW. 2013. Vaginal swabs are the optimal specimen for detection of genital Chlamydia trachomatis or Neisseria gonorrhoeae using thecobas 4800 CT/NG test. Sex Transm Dis 40:247–250.