GENITAL SWABS AND INVESTIGATIONS FOR SEXUALLY TRANSMITTED DISEASES

(see also Molecular detection / HIV infection and MMMP Handbook)

Advice about appropriate testing / outpatient appointments is available from the consultant GUM physician at the Sexual Health clinic (0161 611 4939) or from the UHSM Consultant Microbiologists

	Specimen Type	High vaginal swab
	Optimal time of specimen collection	Before antimicrobial therapy where possible;
	Correct specimen type and method of collection	Symptomatic patients; use Routine swab After the introduction of the speculum, the swab should be rolled firmly over the surface of the vaginal vault and the posterior fornix; sample any candidal plaques if these are present.
	Quantity and number of specimens	One
	Laboratory analysis	Routine: microscopy for trichomonas and bacterial vaginosis; culture for B-haemolytic streptococci, staphylococci and yeasts.
	Transport	Promptly to laboratory; refrigerate if any delay.

	Specimen Type	Cervical urethral swabs - for gonococcal and chlamydial investigation
	Optimal time of specimen collection	Before antimicrobial therapy where possible
	Correct specimen type and method of collection	Use special thin genital swab from the Chlamydia Swab Collection Kit . (please also see Chlamydia and Gonocoocal testing) Ideally contamination with micro-organisms from the vulva or the foreskin should be avoided. When urethral swabs from men are being collected, the patient should not have passed urine for at least 1 hr. For males, if a discharge is not apparent, attempts should be made to "milk" exudates from the penis. The swab is gently passed through the urethral meatus and rotated. In asymptomatic women, if a speculum examination is not possible or refused by the patient then send a vulvo-vaginal swab(s) for NAAT (Nucleic Acid Amplification Technique NAAT) for gonococci and Chlamydia (Orange-labelled container). If the patient is symptomatic, collect also a separate routine swab for gonococcal culture to allow for sensitivity testing of organism.
	Quantity and number of specimens	Where relevant, take rectal swabs for gonococcal culture and for Chlamydia NAAT
	Laboratory analysis	Routine: culture for B-haemolytic streptococci, staphylococci and yeasts which are more likely to be relevant in women.
	Transport	Promptly to laboratory; refrigerate if any delay.

	Specimen Type	Genital ulcer swab
	Optimal time of specimen collection	Before antimicrobial therapy where possible;
	Correct specimen type and method of collection	Moisten swab in sterile saline and rub across the ulcer firmly. Remember blood for syphilis serology if this is a possibility.
	Quantity and number of specimens	One or more swabs, which can be pooled for lab analysis
	Laboratory analysis	For herpes PCR and syphilis PCR.
	Transport	Promptly to laboratory; refrigerate if any delay.

	Specimen Type	Urine - chlamydia and gonococcal investigation
	Optimal time of specimen collection	Before antimicrobial therapy where possible
	Correct specimen type and method of collection	Follow instructions on the Aptima urine specimen collection kit. The patient should not have urinated for at least 1 hour prior to sampling; collect first-catch urine of 20-30 mls.
	Quantity and number of specimens	One
	Laboratory analysis
	Transport	Keep at 2-30oC.

	Specimen Type	Intrauterine contraceptive devices (IUCDs)
	Optimal time of specimen collection	Before antimicrobial therapy where possible
	Correct specimen type and method of collection	The entire device should be sent in a sterile pot.
	Laboratory analysis	Routine: microscopy; culture for ß-haemolytic streptococci, staphylococci and yeasts; prolonged incubation for Actinomyces spp.
	Transport	Promptly to laboratory; refrigerate if any delay.

	Specimen Type	Fluids and pus
	Optimal time of specimen collection	Before antimicrobial therapy where possible
	Correct specimen type and method of collection	These are taken from the Fallopian tubes, tubo-ovarian and Bartholin's abscesses etc during surgery, into a sterile pot. Please indicate if culture for Mycobacteria spp is required.
	Quantity and number of specimens
	Laboratory analysis	Routine: microscopy; culture for B-haemolytic streptococci, staphylococci, anaerobes and yeasts , extended incubation for anaerobic bacteria.
	Transport	If transport is delayed, refrigeration is preferable to storage at ambient temperature. Delays of over 48hrs are undesirable. If delays are expected, send a Routine swab