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Gynaecological swabs

Introduction

  • Wash hands; Introduce self; ask Patient’s name and what they like to be called; Explain examination, why it’s necessary, and obtain consent 
  • Get a chaperone
  • Explain procedure
    • Be impersonal, e.g. ‘It will involve placing a small plastic tube inside the vagina.’
    • ‘It shouldn’t be painful, but if at any point you are uncomfortable or want to stop, just say so. One of the nurses will also be present to ensure you are comfortable and act as a chaperone.’ 
    • Patient should be lying flat in lithotomy position but remain covered initially: ‘You will need to undress from the waist down, put your heels together and bring them as close to your bottom as possible, then flop your knees down outwards.’
  • Before starting, ask about: last menstrual period, intra-menstrual bleeding, discharge, contraception, last smear
  • Ask if the patient needs the toilet before the procedure
  • Position the patient so you are on their right side if possible  

NB: keep talking to and reassuring the patient, using their name throughout.

Gather equipment

  • Gloves and apron
  • Lubricating gel
  • Speculum
  • Swabs as required by local protocol
    • Nucleic acid amplification test (NAAT) swab: endocervical or vulvovaginal for Chlamydia, Gonorrhoea ± Trichomonas ± Mycoplasma genitalium
    • Charcoal media swab: high-vaginal for Bacterial vaginosis, Candida, group B Streptococcus, Trichomonas
  • Wash tray and place equipment inside in partially open packets

Performing the swabs

  • Put on gloves and apron
  • Warm the speculum if necessary with warm water
  • Lubricate the sides of the speculum (not the tip because this may alter results) and warn the patient prior to inserting
  • Part the labia and insert the speculum with the screw sideways
  • Rotate speculum as you advance it so that the screw is facing upwards. Open speculum and tighten screw when resistance is met.
  • Hold it in place with your left hand so it doesn’t slide out
  • Direct light to visualise cervix – look for discharge, erosions, ulcerations, growths, cervicitis, blood, polyps, ectropion
  • To take each swab in turn:
    • Use your right hand to pick up the swab’s sample tube and place this in your left hand (also holding the speculum). Remove the lid and put this back in the tray for the meantime.
    • Take the swab with your right hand
    • Place the used swab back in its tube (held your left hand), tighten the lid and place back in the tray
  • Swabs:
    • Endocervical or vulvovaginal NAAT swab (Chlamydia, Gonorrhoea ± Trichomonas ± Mycoplasma genitalium)
      • Endocervical (thin tipped white swab): place tip in endocervix and rotate for 10-15 seconds; if there is excess discharge around the cervix, consider removing this with a spare swab prior to sampling
      • Vulvovaginal (large tipped white swab): place tip into posterior fornix and rotate for 10-15 seconds; rotate over the lower vaginal walls on withdrawal

Snap the top half of the NAAT swab off into the collection tube once taken.

  • High-vaginal charcoal media swab (Bacterial vaginosis, Candida, group B Streptococcus, Trichomonas): place tip in the posterior fornix and rotate for 10-15 seconds. Place the swab into the collection tube.

NB: in some circumstances (e.g. symptomatic females or if a NAAT swab was positive for Gonorrhoea), another endocervical charcoal swab may also be required for Gonorrhoea culture. This allows antibiotic sensitivity testing, unlike the NAAT swab. This is taken by placing a charcoal swab tip in endocervix and doing one full 360˚ sweep (not rotation).

  • Close speculum blades (but not fully to avoid pinching vaginal wall) 
  • Remove speculum while rotating it back sideways

To complete 

  • Thank patient, give them a tissue and restore clothing
  • Fill in the sample and request form details and send to lab
  • Document in patient’s notes
  • Advise patient results will take approximately 1-2 weeks and how they will get results (they can get them by text if in a sexual health clinic setting)
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