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Taking vaginal swabs is a common OSCE station. You’ll be expected to competently perform the procedure and demonstrate appropriate communications skills with the patient or mannequin. This guide to taking gynaecological swabs OSCE provides a clear step-by-step approach to performing the procedure.

Check out the vaginal swabs OSCE mark scheme here.

 


Introduction 

  • Wash your hands
  • Introduce yourself
  • Confirm the patient’s details (e.g.name and date of birth)
  • Ask if the patient could currently be pregnant
  • Explain the procedure (as shown below)

 

  • Wash hands

 


Explanation

Assess the patient’s current understanding:

  • “I’ve been asked to take some vaginal swabs today.”
  • “Do you understand what this procedure involves?”

 

Explain the procedure:

  • “What the procedure will involve is me inserting a small plastic device called a speculum into the vagina. This will allow me to visualise the inside of the vagina and the neck of the womb.”
  • “The procedure shouldn’t be painful however it will feel a little uncomfortable.”
  • “If at any point you want me to stop the procedure, please let me know. You may also experience some light vaginal bleeding after the procedure.”

 

Explain the need for a chaperone:

  • “For this examination one of the female ward staff will be present acting as a chaperone.”

 

Check the patient’s understanding and gain consent:

  • “Do you understand everything I’ve explained?”
  • “Do you have any questions?”
  • “Are you happy for me to perform the procedure?”

Ask if the patient would like to go to the toilet to empty their bladder before the examination.

 


Gather equipment

  • Clean tray
  • Gloves
  • Lubricant
  • Speculum
  • A light source for the speculum
  • Swabs:
    • High vaginal swab and endocervical swab (charcoal media swabs x2)
    • Chlamydia swab pack (endocervical)

 


Position

The patient should be positioned supine on a bed with their underwear removed  (a modesty cloth should be provided):

  • “I need you to go behind the curtain and remove your underwear. Could you please then get onto the bed and cover yourself with the cloth provided.”

 

Position the patient in the modified lithotomy position:

  • “Bring your heels towards your bottom and then let your knees fall to the side.”

 


Inspection

Preparation

  • Don gloves
  • Open the packaging but leave the equipment inside and place in the clean tray.

 

Inspect the vulva

  • Ulcers (e.g. genital herpes)
  • Abnormal vaginal discharge (e.g. chlamydia or gonorrhoea)
  • Don gloves

 


Inserting the speculum

1. Warn the patient you are about to insert the speculum

2. Use your left hand (index finger and thumb) to separate the labia

3. Gently insert the speculum sideways (blades closed, angled downwards and backwards)

4. Once inserted, rotate the speculum back 90 degrees (so that the handle is facing upwards)

5. Open the speculum blades until an optimal view of the cervix is achieved

6. Tighten the locking nut to fix the position of the blades and hold in place with your non-dominant hand (otherwise, it can slide out)

 

  • Gently insert the speculum sideways with the blades closed

 


Visualising the cervix

Inspect the cervix

  • Cervicitis (e.g. gonorrhoea or chlamydia)
  • Cervical erosions (e.g. ectropion)
  • Masses (e.g. cervical malignancy)
  • Ulcers (e.g. genital herpes)
  • Abnormal discharge (e.g. bacterial vaginosis)

 

  • Inspect the cervix

 


Taking the vaginal swabs

Swab technique

  • Pick up the swab’s sample tube using your dominant hand and pass it to your non-dominant hand (which should also be stabilising the speculum)
  • Remove the lid of the sample tube using your dominant hand and place in the tray
  • Pick up the swab itself with your dominant hand and take the sample (see below for specifics depending on the swab being used)
  • Place the used swab back into its tube, which should still be in your non-dominant hand and tighten the lid
  • Place the completed swab into the tray

 

Double vs Triple swabs

Depending on your local hospital guidelines you may be expected to take “double swabs” or “triple swabs”:

  • Double swabs include a NAAT swab to test for both chlamydia and gonorrhoea and a high vaginal charcoal swab to test for fungal and bacterial infections such as candida albicans and bacterial vaginosis.
  • Triple swabs include an endocervical chlamydia swab (usually in a pink wrapper), an endocervical sample using a charcoal swab to pick up gonorrhoea and a third sample, using a charcoal high vaginal swab to test for fungal and bacterial infections.

 

Swab details

The swabs are listed below in the order which you should take them.

1. Endocervical Chlamydia Swab (NAATS)

Technique:

  • This sample kit comes with an additional cleaning swab
  • The large tipped white cleaning swab should be used to remove excess mucus from the cervical area to allow visualisation of the external os and then discarded
  • Remove the testing swab from the tube and gently insert it into the endocervix by approximately 5mm
  • Rotate the swab for 10-15 seconds in the endocervix
  • Remove the swab and break off into the transport tube at the score line on the shaft
  • Screw the lid onto the sample tightly

 

Screens for:

  • Chlamydia and Gonorrhoea
  • NAATS stands for Nucleic Acid Amplification Tests

 

2. Endocervical Charcoal Media Swab 

Technique:

  • Remove the testing swab from the tube and gently insert it into the endocervix by approximately 5mm
  • Rotate the swab for 10-15 seconds in the endocervix
  • Remove the swab and break off into the transport tube at the score line on the shaft
  • Screw the lid onto the sample tightly

 

Screens for:

  • Gonorrhoea

3. Hi-vaginal Charcoal Media Swab

Technique:

  • Insert the charcoal media swab into the posterior fornix, where discharge frequently pools
  • Rotate the swab for 10 seconds, or for the length of time recommended in the manufacturer’s instructions
  • Place the swab into the sample tube and screw the lid on tightly

 

Screens for:

  • Bacterial vaginosis
  • Trichomonas vaginalis
  • Candida
  • Group B streptococcus

 


Removing the speculum

1. Loosen the locking nut on the speculum and partially close the blades

2. Rotate the speculum 90 degrees, back to its original insertion orientation

3. Gently remove the speculum, inspecting the walls of the vagina as you do so

4. Re-cover the patient

5. Dispose of the speculum and gloves

6. Wash hands

 

  • Loosen the locking nut

 


To complete the procedure…

  • Thank the patient
  • Offer them some tissue to clean themselves
  • Allow the patient time to get re-dressed
  • Label the samples:
    • Name / Date of birth / Patient identification number / Address
    • GP name and address
    • Specimen type
    • Specimen site
    • Other relevant clinical details
  • Send vaginal swab samples for processing
  • Advise the patient that they’ll be contacted with results via their preferred method (e.g. face to face or text message)
  • Document the procedure in the medical notes including the details of the chaperone

 

Suggest further assessments and investigations

 


 

Assessment

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