Vaginal Swabs Clinical Information Why? Murray Robinson Microbiology & Molecular Diagnostic Lead of Specialty

Why do you collect a Vaginal swab? Routine check Clinical abnormality * Clinical history * Because I always do Just in case Because I was there Because the patient asked *With relevant clinical information

Clinical Information Good Reject STI Risk only STI check Discharge Discharge with STI risk ? Thrush ?BV ?Trichomonas Pre TOP Post TOP Post surgery Post partum Miscarriage Pelvic pain ?PID Sexual abuse/assault STI check New partner UPSI Sexually active No clinical details No relevant clinical details Routine screen Pregnant ?Infection Symptomatic Asymptomatic screening NOTE: The Yellow CT/NG NAAT tube is never rejected. CT/NG NAAT = Chlamydia / Gonorrhoea Nucleic Acid Amplification Test

Clinically guided testing eSwab (pink) – 4 possible tests Gram stain – BV, Yeast, Leucocytes Trichomonas culture Culture – “wound” Gp B Strep. screen (pregnant, 35-37 weeks) Roche tube (yellow) CT/NG NAAT – STI screen / STI symptoms CT/NG NAAT = Chlamydia / Gonorrhoea Nucleic Acid Amplification Test

Vaginal swab collection Asymptomatic – no STI risk No clinical reason for testing No swabs No tests – STI risk Clinical information of “STI screen” / “STI check” Yellow CT/NG tube, consider Trichomonas (Pink eSwab) Tests performed: - CT/NG NAAT - Trichomonas culture (if Pink eSwab received) Symptomatic Provide clinical symptoms & reason for testing Pink eSwab only - Gram stain for BV, Yeast - Culture (only if clinical details indicate) Provide clinical symptoms & indicate STI risk Pink eSwab & Yellow CT/NG tube - Trichomonas culture Example clinical details: Routine Pregnant Example clinical details: STI screen STI check UPSI Sexually active New partner Example clinical details: Discharge ?Thrush ?BV Post partum infection Post surgery Example clinical details: Discharge ?STI Pre TOP Post TOP infection Pelvic pain ?PID Sexual abuse / assault CT/NG NAAT = Chlamydia trachomatis / Neisseria gonorrhoeae nucleic acid amplification test; STI = Sexually transmitted infection; BV = Bacterial vaginosis References: http://nzshs.org/docman/guidelines/principles-of-sexual-health-care/148-sexual-health-check-summary/file http://www.bpac.org.nz/resources/handbook/sti/sti.asp?artID=1

Reject comment No clinical details have been provided for laboratory testing of this vaginal swab (trichomonas testing is now NOT possible). - If trichomonas infection is clinically suspected, a repeat swab with specific request is required. - If yeast and BV testing is required provide relevant details. - If chlamydia/gonorrhoea tube was submitted this testing will be performed. (See Clinical Update; Laboratory Processing of Vaginal Swabs - July 2016).

Bad Practise Story Routine smear Because I was there: Vaginal swab – routine Vaginal swab – CT/NG Chlamydia trachomatis (CT) weak positive 3/5 tests Why were Microbiology swabs collected?

Why Clinical Information? Tests performed determined by clinical information Best practise Reduces unnecessary testing Reduces unnecessary treatment Reduces bacterial resistance Enables introduction of new technologies Trichomonas NAAT Other NAAT’s

Trichomonas NAAT Trial Trial to start late May / early June Assess suitably of test Identify high risk cohort Sustainable business case If successful Stop Trichomonas culture Replace with selective Trichomonas NAAT Review NAAT collection tube(s)

http://www.bpac.org.nz/resources/handbook/sti/sti.asp?artID=1

http://nzshs.org/docman/guidelines/principles-of-sexual-health-care/148-sexual-health-check-summary/file

Acknowledgements Microbiology team Dr Michael Addidle Dr Vani Sathyendran You for listening