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11/13/24, 7\:11 PM Guide | Vaginal swabs

Vaginal swabs

Table of contents
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0\:00 8\:07

Gather equipment

Collect the relevant equipment, remove the outer packaging and place it in a clean tray\:
Gloves
Lubricant
Speculum
A light source
Paper towels
Amies (charcoal) medium swab x 2 (high vaginal and endocervical if required)
Nucleic acid ampli
Viral swab (for genital ulcers, if required)
Organise and prepare the swabs for taking samples.
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Gather equipment
Double vs triple swabs
Depending on your local guidelines, for vaginal swabs, you may be expected to take “double swabs” or "triple swabs"
\:
Double swabs\: a NAAT swab (vulvovaginal) and a high vaginal Amies (charcoal) medium swab.
Triple swabs\: a NAAT swab (vulvovaginal), a high-vaginal Amies (charcoal) medium swab and an endocervical Amies
(charcoal) medium swab.
The NAAT kit usually contains two swabs, an endocervical and vulvovaginal. Usually, only the vulvovaginal swab (large-
tipped white swab) is required as it is better at detecting chlamydia and gonorrhoea.

Introduction

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain what the procedure will involve using patient-friendly language\:
" T o d a y I n e e d t o t a k e s o m e v a g i n a l s w a b s . T h e
p r o c e d u r e w i l l i n v o l v e m e i n s e r t i n g a s m a l l p l a s t i c d e v i c e c a l l e d a s p e c u l u m i n t o t h e v a gi n a a n d t h e n t a k i n g s e v e r a l s w a b s
f r o m t h e v a g i n a a n d n e c k o f t h e w o m b . I t s h o u l d n’ t b e p a i n f u l , b u t i t w i l l f e e l a l i t t l e u n c o m f o r t a b l e . Y o u c a n a s k m e t o s t o p a t
a n y p o i n t . Y o u m a y e x p e r i e n c e s o m e l i g h t v a gi n a l b l e e d i n g o r s p o t t i n g a f t e r t h e p r o c e d u r e .
"
Explain the need for a chaperone\:
a s a c h a p e r o n e , w o u l d t h a t b e o k ?”
“ O n e o f t h e f e m a l e w a r d s t a
Gain consent to proceed with the procedure\:
h a p p y f o r m e t o c a r r y o u t t h e p r o c e d u r e ?"
" D o y o u u n d e r s t a n d e v e r y t h i n g I' v e s a i d ? D o y o u h a v e a n y q u e s t i o n s ? A r e y o u
Ask the patient if they have any pain or if they think they may be pregnant before proceeding with the procedure.
Provide the patient with the opportunity to pass urine before the procedure.
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Explain to the patient that they'll need to remove their underwear and lie on the clinical examination couch, covering
themselves with the sheet provided.
Provide the patient with privacy to undress and check whether it is okay to re-enter the room before doing so.

Preparation

1. Wash your hands
2. Open the speculum packaging whilst avoiding touching the speculum or the inner surface of the packaging
3. Open the lubricant onto the inner surface of the speculum packaging
Wash your hands

Position the patient

1. Re-check consent and that the patient is happy to proceed with the examination\:
g e n i t a l s . A r e y o u h a p p y f o r m e t o d o t h i s ?”
2. Position the patient in the modi
t h e b e d , a n d t h e n l e t y o u r l e g s f a l l o p e n”
.
“ D r a w y o u r a n k l e s u p t o w a r d s y o u r b u t t o c k s , “ I’ m g o i n g t o m o v e o n a n d e x a m i n e y o u r
k e e p y o u r f e e t
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Position the patient in the modi

Vulval examination

A vulval examination should be performed before moving on to taking the vaginal swabs. This is to look for any vulval
pathology or lymphadenopathy.
1. Don a pair of non-sterile gloves and an apron
2. Expose the patient's external genitalia and ensure there is adequate lighting
Don apron and gloves

Palpate the inguinal lymph nodes

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1. Palpate the inguinal lymph nodes to identify lymphadenopathy, which may be associated with\:
Acute infections (e.g. chlamydia, herpes)
Malignancy (e.g. vulval cancer)
Palpate inguinal lymph nodes

Inspect the vulva

1. Inspect the vulva for abnormalities\:
Ulcers\: typically associated with genital herpes
Abnormal vaginal discharge\: causes include candidiasis, bacterial vaginosis, chlamydia and gonorrhoea
Scarring\: may relate to previous surgery (e.g. episiotomy) or lichen sclerosus (scarring with associated abnormal
architecture)
Vulvovaginal atrophy\: most commonly occurs in postmenopausal women
White lesions (leukoplakia)\: may be patchy or in a
lichen sclerosus
Other lesions\: causes include folliculitis, molluscum, genital warts and vulval malignancy
Masses\: causes include Bartholin’s cyst and vulval malignancy
Varicosities\: varicose veins secondary to chronic venous disease or obstruction in the pelvis (e.g. pelvic malignancy)
Female genital mutilation\: total or partial removal of the clitoris and/or labia and/or narrowing of the vaginal introitus
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Inspect the vulva and perineum

Vulval swab

If ulcer(s) are noted on the vulva, an additional swab should be taken to exclude syphilis or HSV. Follow local guidelines, but in
many areas, this can be done using a "
viral" swab.
Swab any vulval lesions

Vulvovaginal swab

To take a vulvovaginal swab\:
1. Remove the large tipped vulvovaginal swab from the packet
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2. Pass the tip of the swab through the introitus approximately 5cm into the vagina
3. Rotate the swab for 10-30 seconds against the vaginal walls
4. Remove the swab from the vagina
5. Swab the vulva (around the introitus)
6. Open the NAAT test tube from the packet. An assistant can help open the NAAT test tube. It is important not to spill any
from the test tube or place the swab on any surface, as this may contaminate the sample.
7. Insert the swab into the NAAT test tube and snap the swab against the side of the test tube along the indicated black line.
8. Screw the lid onto the NAAT test tube.
Take a vulvovaginal swab

Inserting the speculum

Warn the patient that you are going to insert the speculum and ask if it is still okay for you to do so.
If the patient consents to continuing the procedure, lubricate the speculum by dipping the speculum into the lubricant on the
internal packaging.
Then, proceed to insert the speculum\:
1. Carefully separate the labia using the thumb and index
2. With the blades closed, gently insert the speculum. Usually, the speculum is inserted with the handle pointing sideways (at 9
or 3 o'clock)
3. Once inserted, rotate the speculum so that the handle is facing upwards
4. Open the speculum blades until an optimal view of the cervix is achieved
5. Tighten the locking nut to
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Lubricate the speculum

Inspection of the cervix and vagina

Inspect the cervix for\:
The cervical os\: if open and the patient is pregnant, this may indicate an inevitable or incomplete miscarriage
Erosions around the os\: most commonly associated with ectropion; however, early cervical cancer can have similar
appearances
Cervical masses\: typically associated with cervical malignancy
Scarring\: from a previous colposcopy procedure (e.g. LLETZ)
Inspect the cervix and vagina for\:
Ulceration\: most commonly associated with genital herpes
Atrophy\: in post-menopausal patients
Foreign body\: for example, a retained tampon or condom
Abnormal discharge\: several possible causes, including bacterial vaginosis, vaginal candidiasis, trichomonas, chlamydia and
gonorrhoea
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Inspect the cervix

High vaginal swab

The high-vaginal Amies (charcoal) medium swab is used to detect infections, including bacterial vaginosis, trichomonas
vaginalis, candida and Group B streptococcus.
To take a high-vaginal swab\:
1. Remove the testing swab from the tube
2. With the speculum in situ, pass the tip of the swab through the speculum to the posterior fornix of the vagina
3. Rotate the swab in the posterior fornix, ensuring you swab any discharge present
4. Remove the swab and insert it into the tube from which the swab was removed from
5. Secure the swab into the tube
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Pass the tip of the swab through the speculum to the posterior fornix of the vagina

Endocervical swab

Amies (charcoal) medium endocervical swab

The endocervical Amies (charcoal) medium swab is used to perform microscopy, culture and sensitivities for gonorrhoea. It is
now often performed only when gonorrhoea has been detected on a NAAT before the initiation of treatment.
To take an endocervical Amies (charcoal) medium swab\:
1. Remove the testing swab from the tube
2. With the speculum in situ, pass the tip of the swab through the speculum to the cervical os
3. Insert the swab gently into the cervical os. If there is excess discharge covering the cervical os, consider using a spare swab
to remove this before inserting the endocervical swab.
4. Rotate the swab in the endocervix
5. Remove the swab and insert it into the tube from which the swab was removed from
6. Secure the swab into the tube
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With the speculum in situ, pass the tip of the swab through the speculum to the cervical os

NAAT endocervical swab (not usually required)

Note\: Always follow local guidelines. Most areas will ask for a vulvovaginal NAAT sample, not an endocervical NAAT
sample. Only one type of swab needs to be taken for a NAAT. An endocervical NAAT swab is not required if you have taken a
vulvovaginal NAAT swab.
To take an endocervical NAAT swab\:
1. Remove the thin endocervical swab from the packet.
2. With the speculum in situ, pass the tip of the swab through the speculum to the cervical os.
3. Insert the swab gently into the cervical os. If there is excess discharge covering the cervical os, consider using a spare swab
to remove this before inserting the endocervical swab.
4. Rotate the swab in the endocervix.
5. Remove the swab and open the NAAT test tube from the packet. An assistant may be helpful to open the NAAT test tube. It is
Source\: geekymedics.com
https\://app.geekymedics.com/osce-guides/clinical-examination/vaginal-swabs/ 11/11