Use Of Vaginal Swabs Research Articles

Do vaginal swabs alter empirical clinical management in obstetrics and gynaecology: A retrospective case-series and activity-based costing of the vaginal swab.

Vaginal swab microbiological testing is commonly performed as routine clinical management for various obstetric and gynaecological presentations. The clinical utility and cost-effectiveness of vaginal swab microscopy, culture and susceptibilities (MCS) in altering empirical management is ill-defined. To describe the clinical use of vaginal swabs in a tertiary women's hospital emergency department (ED), measure the impact of vaginal swabs on altering empirical clinical management, and to determine the economic cost of vaginal swab MCS. Retrospective case-series of vaginal swabs collected at a single, tertiary women's ED between January 2021 and July 2021. Symptomatology, clinical diagnosis, test results, and pre-swab and post-swab clinical management were determined upon medical record review. Economic costs of vaginal swab MCS were retrospectively determined via internal accounting records, permitting unit-level activity-based costing. A total of 660 vaginal swabs from 584 clinical episodes were included. Vulvovaginitis was the most common indication for swab collection (34.5%, 167 samples). Altered empirical management was observed in 9.8% of all swabs (95% CI 7.4-12.2%), with marked variability between clinical indications. Antimicrobial initiation was the most common alteration in management (8.9%, 95% CI 8.7-9.1%). The estimated cost of vaginal swab MCS was $29.71 AUD; labour, consumables and disposal costs accounted for 69.3, 29.8 and 0.9%, respectively. The impact of vaginal swab MCS on empirical clinical management is context-specific and variable. The majority of swabs performed do not impact upon empirical management. Antimicrobial initiation is appreciably more common than antimicrobial cessation with vaginal swab results.

Increasing Vaginal Chlamydia Trachomatis Testing in Adolescent and Young Adults.

The Centers for Disease Control and Prevention recommend testing for Chlamydia trachomatis in sexually active female patients <25 years old using nucleic-acid amplification tests (NAAT) from a vaginal swab. Our providers were typically testing using the less sensitive urine NAATs. We aimed to increase the percentage of urogenital C trachomatis NAATs performed by using vaginal swabs in adolescent female patients ages 10 through 20 years from 1.4% to 25%. We implemented 3 interventions at 3 pediatric practices over 12 months including education, process standardization, and cross-training. We used statistical process control to analyze the effect of interventions on our primary outcome: the percentage of urogenital C trachomatis tests performed with a vaginal swab. Our balance measure was the total number of urogenital C trachomatis tests. There were 818 urogenital C trachomatis tests performed: 289 before and 529 after the first intervention. Of urogenital C trachomatis tests in the preintervention time period, 1.4% were performed by using vaginal swabs. We surpassed our aim of 25% 6 weeks after the first intervention. We noted sustained improvement after the second intervention, with an average of 68.3% of tests performed by using vaginal swabs for the remaining postintervention period. There was no difference in the overall number of urogenital C trachomatis tests pre- and postintervention. Using quality improvement methodology and implementing easily replicable interventions, we significantly and sustainably increased use of vaginal swabs. The interventions standardizing processes were associated with a higher impact than the educational intervention.

P09.07 Prevalence ofmycoplasma genitaliumin patients visiting hiv counselling institutions in north-rhine-westphalia, germany (sti-hit study)

Introduction Patients asking for a free anonymous HIV test may have other STI such as Mycoplasma genitalium (Mg), yet Mg prevalence in that population is unknown. Among other STI, we measured Mg prevalence in patients seeking HIV testing at local public health authorities (LPHA) to inform decision making regarding Mg screening in HIV counselling institutions. Methods LPHA in North Rhine-Westphalia screened patients for Mg infection on the basis of self-collected vaginal swabs and urine samples (men) which were analysed by transcription-mediated amplification assays (APTIMA® Mycoplasma genitalium ). LPHA staff collected information on socio-demographic characteristics, sexual and HIV testing behaviours, previous STI history and clinical symptoms. We assessed overall and group-specific Mg prevalences and their 95% confidence intervals (CI). Using binomial regression, we calculated prevalence ratios adjusted for age and level of education. Results Eighteen LPHA collected 3204 samples, of which seventeen could not be analysed. Of the remaining 3187 samples, LPHA recruited 1751 men, 1430 women and 6 transgenders. The median age was 30 years [25–38]. Overall prevalence of Mg was 3.42% (109/3187; 95% CI: 2.8–4.1%), 72.5% of those who tested positive were asymptomatic. Mg prevalence was 1.4% (16/1174; 95% CI: 0.8–2.2%) in heterosexual men, 2.0% (11/549; 95% CI: 1.0–3.6%) in MSM, 13.6% (39/286; 95% CI: 9.9–18.2%) in female sex workers (FSW) and 3.6% (41/1144; 95% CI: 2.6–4.8%) in other women. After adjusting for age and level of education, Mg infection was 7.4 times [95% CI: 4.0–13] and 2.8 times [95% CI: 1.5–5.0] more prevalent in FSW and in other women, respectively, as compared to heterosexual men. Conclusion The prevalence of Mg was higher in women, especially among FSW. Use of vaginal swabs in women as compared to urine samples in men may have provided more sensitive detection of Mg among women. Increased attention should be paid to Mg screening in patients seeking HIV testing at LPHA, particularly among FSW. Disclosure of interest statement Diagnostic tests were funded by Hologic ® .

Self-Collected versus Clinician-Collected Sampling for Chlamydia and Gonorrhea Screening: A Systemic Review and Meta-Analysis

BackgroundThe increases in STI rates since the late 1990s in Canada have occurred despite widespread primary care and targeted public health programs and in the setting of universal health care. More innovative interventions are required that would eliminate barriers to STI testing such as internet-based or mail-in home and community service testing for patients that are hard to reach, who refuse to go for clinician-based testing, or who decline an examination. Jurisdictions such as New Zealand and some American states currently use self-collected sampling, but without the required evidence to determine whether self-collected specimens are as accurate as clinician-collected specimens in terms of chlamydia and gonorrhea diagnostic accuracy. The objective of the review is to compare self-collected vaginal, urine, pharyngeal and rectal samples to our reference standard - clinician-collected cervical, urethral, pharyngeal and rectal sampling techniques to identify a positive specimen using nucleic acid amplification test assays.MethodsThe hierarchical summary receiver operating characteristic and the fixed effect models were used to assess the accuracy of comparable specimens that were collected by patients compared to clinicians. Sensitivity and specificity estimates with 95% confidence intervals (CI) were reported as our main outcome measures.FindingsWe included 21 studies based on over 6100 paired samples. Fourteen included studies examined chlamydia only, 6 compared both gonorrhea and chlamydia separately in the same study, and one examined gonorrhea. The six chlamydia studies comparing self-collection by vaginal swab to a clinician-collected cervical swab had the highest sensitivity (92%, 95% CI 87-95) and specificity (98%, 95% CI 97-99), compared to other specimen-types (urine/urethra or urine/cervix). Six studies compared urine self-samples to urethra clinician-collected samples in males and produced a sensitivity of 88% (95% CI 83-93) and a specificity of 99% (95% CI 0.94-0.99). Taking into account that urine samples may be less sensitive than cervical samples, eight chlamydia studies that compared urine self-collected verses clinician-collected cervical samples had a sensitivity of 87% (95% CI 81-91) and high specificity of 99% (95% CI 0.98-1.00). For gonorrhea testing, self-collected urine samples compared to clinician-collected urethra samples in males produced a sensitivity of 92% (95% CI 83-97) and specificity of 99% (95% CI 0.98-1.00).ConclusionThe sensitivity and specificity of vaginal self-collected swabs compared to swabs collected by clinicians supports the use of vaginal swab as the recommended specimen of choice in home-based screening for chlamydia and gonorrhea. Urine samples for gonorrhea collected by men had comparably high sensitivity and specificity, so could be recommended as they can be left at room temperature for several days, allowing for the possibility of mail-in home-based testing. In populations that may not go for testing at all, do not have the option of clinical testing, or who refuse a clinical examination, self-collected screening would be a good alternative. We recommend that guidelines on how to self-collect gonorrhea and chlamydia urine, vaginal, rectal and pharyngeal specimens be published.

Prevalence of genital Chlamydia infection in urban women of reproductive age, Nairobi, Kenya.

BackgroundChlamydia trachomatis is one of the major causes of sexually transmitted infections throughout the world. Most infections are asymptomatic and remain undetected. Burden of disease in the Kenyan population is not well characterised. This study was done to define the prevalence of genital Chlamydia infection in a representative female population.FindingsA cross-sectional study design was employed. All women attending out-patient clinics (antenatal, gynaecology, family planning) and accident and emergency departments at two study sites over a five month period were invited to consent to completion of a questionnaire and vaginal swab collection. A rapid point-of-care immunoassay based test was performed on the swabs. Women who tested positive for Chlamydia were offered treatment, together with their partner(s), and advised to come for a follow-up test.A total of 300 women were tested. The prevalence of genital Chlamydia trachomatis was found to be 6% (95% CI 3.31% – 8.69%). The prevalence was higher in women who represented a higher socioeconomic level, but this difference was not significant (p=0.061). Use of vaginal swabs was observed to be a more acceptable form of sample collection.ConclusionThe prevalence of genital Chlamydia is significant in our female population. There is a justifiable need to institute opportunistic screening programs to reduce the burden of this disease. Rapid and low cost point-of-care testing as a potential component of sexually transmitted infection (STI) screening can be utilised.

Advancing STD Detection by Use of Vaginal Swabs

Nucleic acid amplification tests (NAATs) allow highly accurate diagnosis of genital tract infections with Chlamydia trachomatis or Neisseria

Increased recovery of group B streptococcus by the inclusion of rectal culturing and enrichment

Detection of intrapartum carriage of group B streptococcus (GBS) and subsequent antibiotic prophylaxis may prevent GBS infections in neonates. Because the gastrointestinal tract is the primary source of this organism, detection of carrier status requires both rectal and vaginal swabs. Vaginal swabs from 651 obstetric outpatients were plated onto 5% sheep blood agar. A second vaginal and a rectal swab were collected and incubated overnight in an enrichment medium of Todd-Hewitt broth containing antibiotics. By at least one method, 110 (16.9%) patients were positive for GBS. Only 31.8% of these positive patients were detected by direct culture of vaginal swabs. The use of vaginal swabs directly plated onto blood agar identified only three carriers not detected by another method. Inoculation of an enrichment broth with the vaginal swab and subsequent subculture detected 70.9% of the total. The use of both vaginal and rectal swabs with enrichment detected 97.3% of total GBS carriers. A subset of enrichment broths inoculated with vaginal and rectal specimens from 279 patients was tested for GBS by direct latex agglutination (Streptex; Murex Diagnostics, Inc., Norcross, GA, USA). Of the 90 broths that grew GBS on subculture, only 59 (65.6%) were positive by the direct agglutination method. The use of this method, although reducing processing time by 1 day, gave false-negative results for one-third of the GBS-positive broths. An accurate detection of the GBS carrier state can only be achieved by a combination of vaginal and rectal swabs incubated in enrichment broth and subcultured on blood agar.