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Genital tract specimens 1. Female Genital
tract specimens are submitted primarily for the detection of sexually
transmitted pathogens (such as N. gonorrhoeae, Chlamydia trachomatis, lymphogranuloma venereum, HSV,
human papillomavirus [HPV] [with histological confirmation], trichomonads, Haemophilus
ducreyi, group B
streptococci, and Candida infections). If infection is not caused by any of
these pathogens, anaerobic bacteria may be involved. If an anaerobic infection is suspected, transport the specimen in an anaerobic transport
system (Table 2). See Table 1 for N.
gonorrhoeae transport and swab transport
systems. For chlamydial and viral
transport systems, refer to specific test descriptions. a. Amniotic fluid Aspirate
fluid by catheter, at cesarean section, or at amniocentesis. b. Bartholin gland Decontaminate
the skin with povidone-iodine, and aspirate material from the duct(s). c. Cervix (1) Do
not use lubricant during procedure. (2) Wipe
the cervix clean of vaginal secretion and mucus. (3) Rotate
a sterile swab, and obtain exudate from the endocervical glands. (4) If
no exudate is seen, insert a sterile swab into the endocervical canal, and rotate the swab. d. Endometrium Collect
endometrium specimens by transcervical aspiration through a telescoping
catheter. e. Fallopian tubes Obtain
aspirates (preferably) or swab specimens during surgery. Bronchoscopy cytology brushes may be
used if exudate is not expressed. f. Rectal swabs: used primarily to detect N.
gonorrhoeae, Shigella species, HSV, and anal carriage of group
A and group B strep. Pass
the tip of a sterile swab approximately 1 in. beyond the anal sphincter. Carefully rotate the swab to sample the
anal crypts, and withdraw it. Send
the swab in a swab transport, viral transport (for HSV), or N. gonorrhoeae transport system. g. Urethra (1) Collect
specimens 1 h or more after patient has urinated. (2) Stimulate
discharge by gently massaging the urethra against the pubic symphysis through the vagina. (3) Collect
the discharge with a sterile swab. (4) If
discharge cannot be obtained, wash external urethra with betadine soap and
rinse with water. Insert a
urethrogenital swab 2 to 4 cm into the endourethra, gently rotate the swab, and
leave it in place for 1 to 2 s.
Withdraw the swab, and submit it in the appropriate transport system for
culture. h. Vagina Specimens
are also useful in the detection of group A streptococci in children. Use
a speculum without lubricant. Collect
secretions from the mucosa high in the vaginal canal with sterile pipette or
swab. i. Vulva (1) Clean
the surface of the lesion with 0.85% NaCl. If there is a crust on the lesion, remove it. (2) Scrape
the lesion until serous fluid emerges. (3) Wipe
away fluid and debris with sterile gauze.
(Try to avoid bleeding.) (4) Press
the base of lesion until clear fluid is expressed. (5) Aspirate
vesicular fluid with a 26- to 27-gauge needle. OR (6) Unroof
the vesicle, and collect fluid with a sterile swab (for HSV detection) and
place in viral transport medium.
OR (7) Scrape
the base of an open vesicle with a sterile scapel blade, and then rub the base
vigorously with a sterile swab (for HSV) and place in viral transport
medium. 2. Male a. Anal swab Submitted
primarily for the detection of N. gonorrhoeae, Shigella species, HSV, and anal carriage of group A and group B strep. Pass
the tip of a sterile swab approximately 1 in. beyond the anal sphincter. Carefully rotate the swab to sample the
anal the anal crypts, and withdraw it.
Send the swab in a swab transport, viral transport (for HSV), stool
transport (for Shigella sp.) or N. gonorrhoeae transport system . b. Epididymis Used
primarily to diagnose nonspecific bacterial epididymitis and sexually
transmitted epididymitis.
Bacterial epididymitis is most commonly due to members of the family Enterobacteriaceae or pseudomonads and generally occurs in men over 35 years of
age. M. tuberculosis infections generally occur after involvement of the prostate
or seminal vesicles. Sexually
transmitted epididymitis is most commonly due to C. trachomatis and N. gonorrhoeae. Use a
needle and syringe to aspirate material from the epididymis. c. Penile lesion Used
primarily to detect sexually
transmitted pathogens such as N. gonorrhoeae, C. trachomatis, and HSV. (1) Clean
the surface of the lesion with 0.85% NaCl. If there is a crust on the lesion, remove it. (2) Scrape
the lesion until serous fluid emerges. (3) Wipe
away fluid and debris with sterile gauze.
(Try to avoid bleeding.) (4) Press
the base of lesion until clear fluid is expressed, or unroof the vesicle and
collect fluid with a sterile swab, or scrape the base of an open vesicle with a
sterile scapel blade, and rub the base vigorously with a sterile swab (for HSV
detection, submit in viral transport medium). d. Prostatic massage Used
primarily to diagnose acute or chornic prostatitis. For both diseases, gram-negative enteric organisms are the
most frequently isolated pathogens.
N. gonorhoeae is found infrequently
but is sometimes implicated in acute prostatitis. (1) Perform
a digital massage through the rectum. (2) Collect
the specimen in a sterile tube or on a sterile swab. e. Urethra Used
primarily to detect N. gonorrhoeae and C.
trachomatis (1) Collect
specimens at least 2 h after the patient has urinated. (2) Insert
a thin urethrogenital swab 2 to 4 cm into the endourethra, gently rotate it,
leave it in place for 1 to 2 s, and withdraw it. Table
6 Collection considerations for genital tract specimens
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