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

2. 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

3. 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

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

6. 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:

7. 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).

8. 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?

9. 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

10. 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)

13. Acknowledgements Microbiology team Dr Michael Addidle
Dr Vani Sathyendran
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