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Techniques for swab and urine specimen collection

Males

 Urethral specimens

 Patients should not pass urine for at least 4 hours prior to specimen collection.

Distal  urethral  swab

• Performed when
• Discharge present
• Urethritis symptoms
• Confirming a positive urine PCR for gonorrhoea
• Testing a gonorrhoea contact
• Test of cure after treatment for gonorrhoea
• Method
• Massage the urethra from proximal to distal to present any discharge
• Using a cotton swab, discharge present at the meatus is smeared on a slide and air dried and then placed on an appropriate transport medium
• In the absence of a discharge a thin dacron tipped plastic or metal swab is moistened with normal saline and placed 2-3 cm inside the urethra and gently rotated once or twice and removed
• If no slide is made the lab with prepare one from the swab placed in the transport medium
• An air dried smear made at the time of specimen collection is of superior quality
• Gram stain - to assess for
• Polymorphonuclear leucocyte cell count
• Presence of gram negative intracellular diplococci
• Culture for
• Gonorrhoea

 Proximal urethral swab 

• Performed when
• Chlamydia testing required and urine not taken for chlamydia PCR

• Method

• a thin dacron tipped plastic or metal swab is moistened with normal saline and placed 3-4 cm inside the urethra and gently rotated once or twice and removed and placed in an empty transport container

 Rectal specimens 

• proctoscopy should be performed to inspect for lumps, ulcers, pus, bleeding and specimen collection
• swabs are taken for
• Gonorrhoea culture (plate or transport medium)
• Chlamydia PCR (dry or moistened cotton tipped swab)
• Herpes simplex PCR if indicated

 Pharyngeal specimens

• Swabs are taken from each tonsillar fossa for
• Gonorrhoea culture

 Ulcer specimens 

• Dry or moist cotton tipped swabs taken from the ulcer base can be tested for HSV PCR
• Swabs are transported in an empty transport container or in viral culture medium

 First catch urine 

• Should not pass urine for at least 3 hours before the sample collection
• First 10ml of urine is collected
• Voiding within 30 minutes prior to sample collection should be considered in interpreting results

 Females

Samples are taken during speculum examination. 

Endocervical specimens 

• A Pap smear is taken first if due or indicated
• A cotton tipped swab is inserted into the cervical canal only 0.5 cm and
• Smeared on a slide and air dried for gram stain
• Placed in a transport medium for gonorrhoea culture
• A second cotton tipped swab is inserted 0.5 – 1cm into the cervical canal and kept in place for 10-15 seconds and rotated 1-2 times for
• Chlamydia PCR testing (place in a empty transport container)

 Vaginal specimens

• From the lateral vaginal wall with a cotton tipped swab
• Smeared on a slide and air dried for gram stain for bacterial vaginosis and candida
• Placed in a transport medium for gonorrhoea culture and candida culture
• From the posterior fornix with a cotton tipped swab for
• pH performed on a pH strip at the time
• wet preparation for trichomonas
• smear on to a slide and place a drop of normal saline on slide - must be read immediately

Rectal specimens 

• these are taken if clinically indicated
• samples are collected as described above

 Pharyngeal specimens 

• these are taken routinely in sex workers
• samples are collected as described above

 Ulcer specimens 

• Dry or moist cotton tipped swabs taken from the ulcer base can be tested for HSV PCR
• Swabs are transported in an empty transport container or in viral culture medium

 First catch urine 

• Can be performed if no endocervical swabs are available
• Sample taken as described above

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