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Introduction ⬇

These tests are done for patients with genital ulcers, vaginal lymphadenopathy, bacterial vaginosis (pathogens such as Gardnerella, Bacteroides, Prevotella, and Mobiluncus), lesions affecting epithelial surfaces, signs and symptoms of bacterial sexually transmitted infections (STIs), pelvic inflammatory disease, urethritis, or abnormal discharge and itching.

Procedure ⬆ ⬇

  1. For cervical specimens:

    1. Be aware that the cervix is the best site from which to obtain a culture specimen.

    2. Observe standard precautions.

    3. Moisten the vaginal speculum with warm water; do not use a lubricant. Remove cervical mucus, preferably with a cotton ball held in a ring forceps.

    4. Insert a sterile, cotton-tipped swab into the endocervical canal; move the swab from side to side; allow 30 seconds for absorption of organisms by the swab (Figure 7.2).

  2. For vaginal specimens:

    1. Observe standard precautions.

    2. Collect a vaginal fluid sample on a swab by contacting the lower one third of the vaginal wall. The swab is placed for 10 minutes in a test vessel to which a developer solution has been added. The solution will turn blue or green if positive (OSOM BVBLUE Test, Sekisui Diagnostics, Lexington, MA).

    3. Using an immunographic assay, a vaginal fluid sample is obtained by a swab that is subsequently placed in a test tube to which a sample buffer has been added. The results are read after 10 minutes (OSOM Trichomonas Rapid Test, Sekisui Diagnostics, Lexington, MA).

  3. For urethral specimens (male patients):

    1. Observe standard precautions.

    2. Use a sterile swab to obtain the specimen from the anterior urethra by gently scraping the urethral mucosa (Figure 7.3).

    3. Rotate the swab 360° to dislodge some of the epithelial cells for Chlamydia trachomatis. N. gonorrhoeae organisms inhabit the exudate, whereas C. trachomatis organisms are intracellular (within the epithelial cells).

  4. For anal canal specimens:

    1. Observe standard precautions.

    2. Insert a sterile, cotton-tipped swab approximately 2.5 cm into the anal canal. (If the swab is inadvertently pushed into feces, use another swab to obtain the specimen.)

    3. Move the swab from side to side in the anal canal to sample the crypts; allow several seconds for absorption of organisms by the swab.

    4. Remember that this site is likely to be positive in a patient with STI, when a cervical specimen is negative.

  5. Swabs for culture should be transported to the laboratory in Stuart transport medium and should be held at room temperature until processed.

  6. If specimens are not processed within 12 hours, they should be refrigerated. Recovery of a pathologic organism may be more difficult because of delay in processing.

Procedural Alert

  1. If the male urethral culture is negative but gonorrhea is still suspected, prostatic massage may produce an increased number of organisms in the urethral discharge. The first morning specimen before urination may be the best.

  2. In a female patient, the anal canal specimen can be obtained after the cervical specimen without changing the patient’s position and without using the anoscope.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain purpose of and procedure for specimen collection. Assess for and document signs and symptoms of infection (drainage, pain, itching).

  2. Place the patient in the dorsal lithotomy position and appropriately drape for genital procedures. Provide as much privacy as possible.

  3. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient appropriately.

  2. Explain need for possible follow-up testing and treatment. The use of pre-exposure vaccines (e.g., hepatitis A and B [frequently sexually transmitted] and human papillomavirus) is the most effective means of preventing STIs.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Clinical Alert

The finding of repeated negative cultures for gonococci does not always exclude a diagnosis of gonorrhea.

Reference Values ⬆

Normal

Negative: normal flora; negative for pathogenic antigens