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[Stayin’ Alive]: No! More! Swabs! The Better Way to STD Test

Men, ever been swabbed for STDs? That medieval practice is disappearing as more places in Shanghai now offer non-invasive urine testing.
Last updated: 2018-10-23

Men in China know the swab. They fear the swab, they hate the swab and there is nothing they can do to avoid the swab on their trip to sexual health and responsibility. To clarify, the swab is when the doctor forcibly opens the urethra (whose default setting is 'closed'), and inserts and swirls around a thin, long instrument topped with an absorbent material. If you are lucky, it only hurts. If you are not, it can lead to bruising of the urethra, which is not a place you want to bruise. In a sick twist, a healthy STD-free urethra, a urethra there just to be safe and responsible and considerate of a partner, is more painful to have swabbed than an infected one. It's too gross to explain why.

What's worse is that most of the Western world left this playful, getting-to-know-you technique behind long ago in the medical waste bin of STD history.

So why, men, why, must we go through this here in China? (Incidentally, women do not have a choice and must be swabbed, though it does not cause the trauma it does for men. Anatomically speaking.)

Well, the answer is, you don't. There is a growing number of clinics in China, and, more importantly, in Shanghai, that offer urine testing for bacterial STDs like chlamydia and gonorrhea. One has been doing it for years. The others are more recent. And one will start soon because of our questioning. Yes, it will cost you more, but if there is a worthy way to spend your hard-earned money, avoiding the spectre of another man shoving a swab up in, and potentially bruising, your urethra, seems like good value.


Why is This a Thing?

It’s a bit of a mystery why more clinics in Shanghai can’t offer comfortable STD testing for men. Family Medicine Physician Dr. Peggy Lu from Shanghai United Family speculates that since testing a urine sample requires more complex technical steps and is more labor-intensive, it’s possible clinics are just opting out. A second doctor at Jiahui Clinic, a place that doesn’t offer the urine alternative, is equally puzzled, acknowledging that if less invasive tests are made available, more men would elect to get tested.

“Shanghai United Family is fourteen years old and this testing has been offered here since day one,” Dr. Lu explains. “A urine test is less invasive and more reassuring for the patient and a chlamydia or gonorrhea test for men can be done either through a urine sample or a swab.”

Viruses like HIV, hepatitis B, and herpes are diagnosed through a blood test. Bacterial STDs like chlamydia and gonorrhea can be diagnosed either through urine samples or samples taken by swabbing.

So why should the men of Shanghai suffer? Doctors I spoke to offered various theories from poor quality drinking water interfering with urine sampling (uh...) to the potential 'patient error', which means the ability to pee in a cup (again, uh...).

Jiahui International Hospital concluded it’s a tech problem: “Most reagents [what’s used to test sample kits] in the Chinese market can only accept urethral swabs according to manufacturer instructions.” Simple answer: they're not set up for it. Circular logic. The serpent bites its tail.

How It Works

At Shanghai United Family, urine samples are tested either by a process called Polymerase Chain Reaction (PCR) or through culture. In PCR the sample is tested for the antigen, which is part of the bacteria. In culturing, bacteria is grown to see what's in there. Dr. Lu continues, “The antigen test is preferred for chlamydia because the result turn-around is only half an hour; we can have the patient wait and give results. For gonorrhea it’s different because the bacteria is more robust, so culture is more accurate.”

Regardless of the lab test, you won't be swabbed.


Where You Can Go

Shanghai United Family has been quietly doing the pee test for more than a decade. Columbia Clinic has been doing it for four years, and Parkway Health has walked into the modern age in the past year or two.

Shanghai United Family: SUF is located in Hongqiao, and has English-speaking nurses and doctors. It's a classic international clinic, open 24/7 with their own lab on site. Consultation: 500-1,000rmb. Testing: 900rmb+.

Parkway Health: Everyone knows Parkway, right? The big healthcare chain with a roster of international docs, like SUF, didn't make any waves about their upgrade but they definitely offer the service, for a price. That price? Consultation: 1,300rmb. Testing 1,000rmb+

Columbia Clinic: A five-minute walk from Jing’an temple, Columbia Clinic is another western-style clinic with international doctors. It is an affiliate of Columbia Asia, a network of 29 hospitals and clinics across Malaysia, India, Vietnam, and Indonesia. Consultation: 500-1,000rmb. Testing: 900rmb+ or a package deal for 1,500rmb.

After we started asking questions, Jiahui Clinic announced they have plans to leave their old reagents behind for NAAT, another way to accurately test urine samples for bacterial STDs .

If you want to subject yourself to the swabs (financial constraints, masochism, etc.) the Shanghai Skin Disease and STD Clinic makes it easy enough for novices to take care of all their testing needs on the cheap. We’ve written about it before, read more. Expect to pay about 250rmb in total for tests; add HPV and herpes for 400rmb more. Urethral bruising is, as ever, free.