Note: NAAT refers to Nucleic Acid Amplification Test, such as PCR
Patients should not pass urine for at least 2 hours prior to specimen collection.
Distal Urethral Swab
confirming a positive urine NAAT for gonorrhoea
testing a gonorrhoea contact
test of cure after treatment for gonorrhoea.
Massage the urethra from proximal to distal to present any discharge
using a cotton swab, discharge present at the meatus is smeared on a slide and air dried and then placed on an appropriate transport medium
in the absence of a discharge a thin dacron tipped plastic or metal swab is moistened with normal saline and placed 2 to 3 cm inside the urethra and gently rotated once or twice and removed
if no slide is made the lab with prepare one from the swab placed in the transport medium
an air dried smear made at the time of specimen collection is of superior quality.
Gram stain - to assess for:
polymorphonuclear leucocyte cell count
presence of gram negative intracellular diplococci.
Culture for gonorrhoea.
Proximal Urethral Swab
Performed when chlamydia testing required and urine not taken for chlamydia NAAT.
A thin dacron tipped plastic or metal swab is moistened with normal saline and placed 3 to 4 cm inside the urethra and gently rotated once or twice and removed and placed in an empty transport container.
Proctoscopy should be performed to inspect for lumps, ulcers, pus, bleeding and specimen collection.
Swabs are taken for:
gonorrhoea culture (plate or transport medium)
chlamydia NAAT and gonorrhoea NAAT (dry or moistened cotton tipped swab)
herpes simplex NAAT if indicated.
Swabs are taken from each tonsillar fossa for:
gonorrhoea culture if suspected or NAAT positive
chlamydia and gonorrhoea NAAT for screening.
Dry or moist cotton tipped swabs taken from the ulcer base can be tested for HSV NAAT
swabs are transported in an empty transport container or in viral culture medium
syphilis NAAT dry cotton tipped swab.
First Catch Urine
Should not pass urine for at least 2 hours before the sample collection
first 10 ml of urine is collected
voiding within 30 minutes prior to sample collection should be considered in interpreting results
tests for chlamydia NAAT, gonorrhoea NAAT, mycolplasma genitalium NAAT and trichomonas vagnilais NAAT as indicated.
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