Clinical use
Diagnosis of genital infections (excluding penile swabs)
Background
A range of sexually transmissible organisms cause infections responsible for many clinical syndromes. When a specific STI is diagnosed, it is recommended to screen for other infections. Genital investigation is also to be performed to detect Trichomonas infection, caused by the flagellate protozoan T. vaginalis, yeast infections or any other abnormal bacterial growth.
Normal vaginal flora is dependent on several factors such as the age of the individual, menstrual cycle and pregnancy, and consists of a wide range of organisms including Lactobacillus species, streptococci, enterococci and coagulase-negative staphylococci. Anaerobes, such as Bacteroides species and anerobic cocci, Gardnerella vaginalis, yeasts, coliforms, Ureaplasma urealyticum and Mycoplasma species may also be present as part of the normal flora, but they have also been incriminated in vaginal infections. Vaginal candidosis occurs when alterations in the vaginal environment allow yeasts (which are often present as commensal organisms in the vagina), to proliferate. Increased levels of oestrogens promote their growth. Yeast overgrowth is often seen after antimicrobial therapy or when the patient has the following conditions: diabetes mellitus, immunosuppression, obesity, pregnancy.
Clinical details provided tailor the tests carried out on the sample.
Patient preparation
Be sure to obtain a representative sample. Ensure the site is specified on the sample container and request form from the below list:
- HVS
- LVS
- Endocervical
- Urethral
- Vulval
- Other (please provide specific site)
On the request form, please give all relevant history. Please specify:
- Post-operative
- Age
- Post-natal (<6 weeks)
- Miscarriage
- Pregnancy
- Toxic chock syndrome
- Abscess
- PID
- Fever
Cervical swab
- Collect endocervical sample by speculum examination.
- Remove any mucus or vaginal material from the cervical outer surface.
- Insert the swab into the cervix and leave it inside the cervix for a few seconds.
- Remove swab from cervix and avoid contact with vaginal mucosa when withdrawing the swab.
Male urethral swab
- Express exudate from the urethra and collect it on a swab.
- If no exudate is available insert a swab into the male urethra, rotate and remove it.
Specimen requirements
E-swab: pink top or orange top
Please see associated E-swab collection guide for detailed sample collection information.
Limitations and restrictions
- Ensure endocervical swabs are sent for N. gonorrhoea investigation. High and low vaginal swabs are not suitable samples for identification of N. gonorrhoea.
- An endocervical/high vaginal swab is not an appropriate specimen to diagnose pelvic inflammatory disease caused by actinomyces. Please send aspirate/pus/IUCD.
Turnaround time
4 days
Analysing laboratory
Microbiology Lab, James Cook University Hospital, Marton Road, TS4 3BW