Beth Israel Deaconess Medical Center Laboratory Manual

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Acceptable specimens for culture include: Cervix, fallopian tubes, urethra, epididymis, rectum, lymph nodes and buboes, conjunctival swab, nasopharyngeal swab or aspirate, tracheobronchial aspirate and bronchoalveolar lavage. Cervical and urethral swabs and urine samples are routinely processed by PCR unless it is a suspected rape case or the patient is pre-pubescent.  Note: chlamydia culture is no longer performed at BIDMC, but is a sendout test.

Unacceptable specimens for culture include: Peritoneal fluid, vagina and vaginal discharge from adult women, fluid from the pouch of Douglas (cul-de-sac), urine & urethral meatus and discharge, throat and oropharynx from adults, exudates, discharge, scrapings with squamous cells

Materials: Transport media and swabs are available from the Laboratory by calling 617-667-2307

Note: The swab provided by the lab is non-toxic for Chlamydia. ONLY use this swab to collect specimens for chlamydia culture. Chlamydia transport media (M4-RT), also used for viral culture specimens, is stored at room temperature and can be used until expiration date.

• Cervix – Endocervical specimen from squamocolumnar junction
 
Swab - Insert swab into the squamocolumnar junction until dacron is just visible, rotate swab for 5-10 seconds and remove.
 
• Fallopian tubes – lumenal swab or fimbriae biopsy
  

• Urethra – lumenal or endourethral swab, 2-4 cm into the urethra, rotate swab for 5-10 seconds and remove.

• Epididymis – aspirate under local anesthesia by injecting sterile physiological saline and withdrawing fluid.
• Ocular – Conjunctival scrapings and/or swabs
• Rectal – Only collect from symptomatic patients.

• Lymph nodes or buboes – aspirate with syringe inserted through healthy tissue and not directly through bubo

• Ocular – Conjunctival scrapings and/or swabs

• Neonatal Respiratory Specimens - deep nasopharyngeal swab, tracheobronchial aspirate, bronchial lung biopsy

• Rectum, Throat, Vagina - Our hospital does not have chain of custody.  Tests performed on specimens from these sites are for medical purposes only.  For sexual assault evaluation, please contact the Child Protection Team at Boston Medical Center to arrange for appropriate testing through their program (pager: 617-638-5795 #7336).
  

• Place the swab in the vial containing M4-RT medium.
• Break off the shaft
• Cap tightly so that leakage will not occur.
• Label the specimen and fill out the requisition slip
• Send to Lab, ON ICE
• Put ice in a bag and seal it up. Put the specimen in a separate plastic bag. Then take a 3rd plastic bag and wrap it around the other two bags.
COLLECTION OF CERVICAL AND URETHRAL SPECIMENS
FOR DETECTION OF Chlamydia trachomatis

	Cervix	Urethra (Male)
Preliminary	Getting a good clean endocervical sample is critical for diagnosis. Clean ectocervix before sampling for all tests including Pap smear	Patient should be instructed not to urinate for one hour before sampling.
CRITICAL STEP! Clean Area
	Wipe ectocervix with large swab to remove mucus and pus. Discard swab.	Express and discard any pus or exudate.
Insert Collection Device
	Insert swab provided by Microbiology into endocervical canal until the tip is no longer visible.	Insert small swab 2-4 cm into urethra.
Gather Cells
	Rotate swab for 5-10 seconds inside canal.	Gently rotate swab to dislodge cells. Allow swab to remain in urethra for about 2 secs.
Withdraw	Withdraw swab without touching any vaginal surfaces.	Withdraw swab.

Steps	Conjunctiva		Nasopharyngeal Aspirate
Preliminary			Follow instructions for collection of nasopharyngeal aspirates .
CRITICAL STEP! Clean Area	Gently remove any pus or discharge.
	If both eyes are to be sampled, swab less-affected eye first.		Collect specimen  (see "Nasopharyngeal Aspiration " in Collection Guidelines)
Insert Collection Device			Rinse catheter (if necessary) with 2.0 ml chlamydia transport medium
Gather Cells	Swab inside of lower, then upper lid using the swab provided by Microbiology. It is non-toxic for Chlamydia.