A further update has been released in the form of a letter from Pauline Wright (Microbiology Department, Southern General Hospital) in regards to vaginal swabs. The contents of the letter can be read below.
Letter From Pauline Wright:
Vaginal swab microbiology testing: need for clinical information
Thank you for your cooperation in adhering to the 2011 GGC guidance regarding the investigation of vaginal discharge in women of reproductive age. To recap, this recommends that a vaginal swab should be taken in the following circumstances: recurrent symptoms, treatment failure, symptoms of PID, postpartum or post gynaecological instrumentation1. In addition we will process samples from pregnant patients.
Samples from under 16’s, over 55’s and other non-vaginal genital samples will be processed as normal. Samples from postmenopausal women under 55 will also be processed if this is indicated on the request form.
In line with our previous communication via the weekly GP email, we have started processing only vaginal swab culture requests that clearly meet the defined clinical criteria. We have had some constructive feedback and would like to take this opportunity to give an update on the implementation of the guidance. The main reasons for sample rejection are listed below:
- Clinical details are left blank or “PV discharge” only. To ensure appropriate samples are processed please supply the necessary clinical details as above.
- For suspected STI, the appropriate sample is a vulvovaginal / endocervical swab in a Multi-Collect transport tube sent to the West of Scotland Specialist Virology Centre (GRI, Glasgow) for chlamydia and gonorrhoea NAAT.
- Clinical details indicate “bleeding” only. If PID is suspected, please indicate clearly on the request form.
- Clinical details indicate “? BV” or “? thrush” only. Empirical treatment should be given based on examination and vaginal pH. Samples should only be sent for culture in the event of failed treatment / recurrent symptoms.
Other samples which have been rejected included clinical details “’trying to conceive’, ‘at smear’ and ‘odour’. We have also rejected samples mentioning “persistent” discharge unless it is clear on the request form that this represents failed treatment / recurrent symptoms. GP Order Comms has been designed to reflect this guidance and will prompt the requester to indicate relevant clinical details. This should make the process more straight forward.
Advice and support on this guidance is available from the Sexual Health advisors at the Sandyford Initiative as part of the Shared Care Initiative by phoning the helpline on: 0141 211 8639. Women with troublesome recurrent symptoms can also be referred for specialist advice to the Sandyford (via SCI Gateway), where they can access in-clinic microscopic assessment of vaginal discharge and receive advice on appropriate suppressive treatments if needed.
We appreciate your continued support and cooperation, and value your feedback. Please forward this to all relevant staff. On behalf of the NHSGGC Medical Microbiology Department, in partnership with the BBV & STI Diagnostic Working group.
