Beth Israel Deaconess Medical Center Laboratory Manual

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The routine method for detection of Neisseria gonorrhoeae and Chlamydia trachomatis from genital sources is now PCR.  For other genital pathogens, a generic genital culture is no longer offered and has been replaced with pathogen-specific testing to provide optimal detection.  Culture techniques remain available for N. gonorrhoeae, which will be used upon request from genital sources in a patient who has experienced treatment failure and in cases of disseminated infection.  Other genital pathogens which may be cultured include: Chlamydia trachomatis (culture done only in cases of rape and prepubescent children; or from rectal and extra-genital sites where PCR testing for Chlamydia trachomatis is not FDA approved; refer to specific instructions for specimen collection), Group B streptococcus, yeast, and Staphylococcus aureus in cases of suspected toxic shock.  In addition, Bacterial Vaginosis (BV) is now detected by smear which provides optimal sensitivity and specificity and replaces culture for Gardnerella vaginalis.

Specific instructions for sampling the cervix and urethra are provided below. However, these are NOT the appropriate guidelines for C. trachomatis (see Guidelines for Culture of Chlamydia trachomatis ). For other organisms, (e.g., Mycoplasma) consult either the alphabetical listing of tests in the "Culture" section or the index.

Cervix culture

• Place the patient in the lithotomy position.
• Insert a speculum, without using a lubricant other than warm water, and visualize the cervical os.
• Remove excess mucus with a large cotton swab.
• Insert the swab provided with the swab transport system into the endocervix, rotate gently, allow it to remain in place for 10-30 seconds and then remove.
• Put swab into transport medium.
• Cervical cultures are not optimal for screening for carriage of Group B beta hemolytic streptococcus. Instead, obtain cultures from the anorectal/vaginal area. (see "Culture, Group B Strep".)
• When suspecting Bacterial Vaginosis or yeast vaginitis, the optimal sample is a vaginal swab (not a cervical swab).
• For cervical culture of Chlamydia , see Guidelines for Culture of Chlamydia trachomatis.
  

• Optimally obtain specimen prior to urination. If not, collect it at least 1 hour after urination.
• For culture of Neisseria gonorrhoeae , use an ENT wire or dacron 1 swab (this can be obtained from the clinical Microbiology Laboratory by calling 617-667-2307) and insert the swab a short distance into the urethra.
• Let it remain in place for 30 seconds, then remove it, and put into the transport medium.
• Using another swab, obtain additional material to make a slide for Gram stain analysis. Gently roll the swab over the slide back and forth, to more evenly distribute the contents of the swab onto the slide.