Source Test Name names Sampling Information Collection Processing Information/ Vagina / Group B Swab the lower vagina followed by the rectum. transport Rectal/Anal Streptococcus Vaginal swabs alone are inadequate specimens. media Vagina (Age 12 yrs and younger) Vagina (Age 12 yrs and younger) Vagina (Age 13 yrs and younger) Group B Streptococcus Screen C&S (Routine ) Candida/Yeast Neisseria gonorrhoeae (GC) Obtain secretions from the mucosal membrane of the vagina with a sterile swab. If a skin swab of vulva or labia, area, please refer to "Genital-Intact Skin" If suspected sexual assault/abuse, please refer to "STI (Assault/Abuse) Obtain secretions from the mucosal membrane of the vagina with a sterile swab. If a skin swab of vulva or labia, area, please refer to "Genital-Intact Skin" In age group of 13 years and younger, if a sexually transmitted disease is being investigated it is recommended that a urine specimen be submitted for testing. Positive specimens are sent to BCCDC for testing with a second set of primers. transport media transport media Collect urine and transfer to Aptima Urine Collection kit Aptima vaginal swab also acceptable or to lab within 12 or to lab within 12 or to lab within 12 or to lab within 12 bag separately to. Information CUGBS/ Vaginal/Rectal GBS Screen Order includes screening culture for Group B streptococcus carrier status CUVAGINAA/ Vagina C&S-Age<13yr or >59yr including Yeast (Candida) If skin swab of vulva or labia, area, please refer to "Genital-Intact Skin" CUVAGINAA/ Vagina C&S-Age<13yr or >59yr including Yeast (Candida) If skin swab of vulva or labia, area, please refer to "Genital-Intact Skin" CHLGCURINE/ Urine-Chlamydia/GC If vaginal swab collected: CHLGCVAGINA / Vagina-Chlamydia/GC Page 1 of 11 Genital and STI s Nov 2018
Source Test Name names Vagina (Age 13 yrs Chlamydia trachomatis and younger) Sampling Information Collection Processing Information/ In age group of 13 years and younger, if a Collect urine and sexually transmitted disease is being transfer to Aptima or investigated it is recommended that a urine Urine Collection kit to lab within specimen be submitted for testing. 12 bag separately to. Positive specimens are sent to BCCDC for testing with a second set of primers. Aptima vaginal swab also acceptable Information CHLGCURINE/ Urine-Chlamydia/GC If vaginal swab collected: CHLGCVAGINA / Vagina-Chlamydia/GC Vagina (Age 13 yrs and younger) STI (Assault/Abuse) In age group of 13 years and younger, if a sexually transmitted disease is being investigated it is recommended that a urine specimen be submitted for testing. Positive specimens are sent to BCCDC for testing with a second set of primers. Collect urine and transfer to Aptima Urine Collection kit Aptima vaginal swab also acceptable or to lab within 12 bag separately to CHLGCURINE/ Urine-Chlamydia/GC If vaginal swab collected: CHLGCVAGINA / Vagina-Chlamydia/GC Page 2 of 11 Genital and STI s Nov 2018
Source Test Name names Sampling Information Collection Vagina (Age 13 yrs C&S (Routine ) Bacterial Vaginosis and older) Trichomonas Collect using speculum without lubricants. Wipe away an excessive amount of secretion or discharge. Obtain secretions from the mucosal membrane of the vaginal vault with a sterile swab. If Trichomonas also ordered or for chronic / recurrent infection, collect a second swab for Trichomonas testing. **If patient is 13 years and If suspected sexual assault/abuse, please refer to "STI (Assault/Abuse). If skin swab of vulva or labia, area, please refer to "Genital-Intact Skin" for collection and ordering instructions Swab(s) in clear Processing Information/ Information If patient is >59 years of age, always order: CUVAGINAA/ Vagina C&S-Age<13yr or >59yr IF "initial presentation" or order with no diagnosis/history order as: CUVAGINA/ Vagina BV/Candida/Yeast Screen Order includes only a Gram stain for BV (Bacterial vaginosis) and Yeast (Candida) IF "routine prenatal/antepartum screen": CUVAGINA/ Vagina BV/Candida/Yeast Screen Order includes only a Gram stain for BV (Bacterial vaginosis) and Yeast (Candida) IF "chronic or recurrent" infection order as: CUVAGINAC/ Vagina C&S- Chronic/Recurrent Order includes Gram stain, Trichomonas screen and Yeast (Candida) culture If "relevant" diagnosis such as post C- section, intrapartum/post partum, post hysterectomy, post pelvic radiotherapy, premature labour, ruptured membranes, toxic shock syndrome, pessary or foreign device order as: CUVAGINAR/ Vagina C&S-Relevent Diagnosis Order includes Gram stain and routine culture. Vaginal specimens are NOT appropriate for anaerobic culture as anaerobes are part of the usual genital flora. If a skin swab of vulva or labia, area, please refer to "Genital-Intact Skin" Page 3 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Vagina (Age 13 yrs Trichomonas vaginalis and older) Vagina Mycoplasma/ Mycoplasma hominis urealyticum PID (Pelvic Inflammatory Disease) Vagina Chlamydia trachomatis STD GC Collect using speculum without lubricants. Wipe away an excessive amount of secretion or discharge. Obtain secretions from the mucosal membrane of the vaginal vault with a sterile swab. Please submit a separate swab for all Trichomonas requests if ordered in conjunction with other tests. Collect without use of any lubricants, creams or antiseptics. Obtain secretions from the mucosal membrane of the vaginal using swab included in the viral transport kit. Carefully insert swab into the opening of the vagina about two inches and gently rotate swab for 10 30 seconds. Make sure the swab touches the walls of the vagina so that moisture is absorbed by the swab. Withdraw without touching skin. Place the swab in the transport kit, breaking the shaft at the score line. Secure lid firmly. Note: Clinicians may instruct their patients to self collect the specimen. **IH Patient Collection Instructions available** Cervix C&S (Routine ) Visualize the cervix using a speculum without lubricant. Remove mucus and secretions from the cervix with a swab and discard the swab. Firmly, yet gently, sample the endocervical canal with a newly obtained sterile swab. - If routine cervicitis, please collect specimen for Chlamydia/GC testing instead. UTM Universal Medium for Virus Testing: Aptima vaginal swab kit Sent to BCCDC (forwarded to NML) frozen or refrigerated bag separately to Information If vaginal culture also requested order as and submit two swabs: CUVAGINAC/ Vagina C&S- Chronic/Recurrent Order includes Gram stain, Trichomonas screen and Yeast (Candida) culture If only Trichomonas screen requested: TRICH/ Trichomonas Screen- Vagina GENMYCOPCR /Genital Mycoplasma/ Investigation of "genital" mycoplasmas (Mycoplasma hominis / urealyticum) CHLGCVAGINA/ Vagina-Chlamydia/GC CUCERVIX/ Cervix C&S- Revelant Diagnosis Bacterial culture should be only ordered on patients with clinically relevant diagnosis e.g. pregnancy complications, post surgery /radiotherapy, toxic shock, IUD infections.. Please indicate diagnosis/history. If routine cervicitis, please collect specimen for Chlamydia/GC testing instead. s Page 4 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Cervix (GC) Cervix Chlamydia trachomatis LGV Lymphogranuloma venereum Cervix STI (Assault/Abuse) (adult) Using large white shaft "cleaning" swab, remove excess mucous. Discard this swab. Using smaller blue shaft swab, insert swab into endocervical canal and rotate 10-30 seconds to ensure adequate sampling. Withdraw swab carefully avoiding contract with vaginal mucosa. Place swab into transport kit, breaking shaft at indicated score line. Secure lid firmly. If suspected sexual assault/abuse, please refer to "STI (Assault/Abuse)" If suspected treatment failure, testing should be performed by culture to allow for susceptibility testing. Using large white shaft "cleaning" swab, remove excess mucous. Discard this swab. Using smaller blue shaft swab, insert swab into endocervical canal and rotate 10-30 seconds to ensure adequate sampling. Withdraw swab carefully avoiding contract with vaginal mucosa. Place swab into transport kit, breaking shaft at indicated score line. Secure lid firmly. If suspected sexual assault/abuse, please refer to "STI (Assault/Abuse)"If lympogranuloma venereum (LGV) suspected, consult microbiologist. No screening recommended for chlamydia/gc. Prophylactic treatment is best practice. Testing: swab kit For culture: Swab in clear transport media swab kit bag separately to bag separately to Information CHLGCCERVIX/ Cervix-Chlamydia/GC If culture collected: CUCERVIXGC / Cervix- GC (Gonorrhea) CHLGCCERVIX/ Cervix-Chlamydia/GC If chanchroid, donovanosis or Lymphogranuloma venereum (LGV) suspected, please contact microbiologist Effective fall 2015 - Refer to IH SAVR policy and procedure manual s Page 5 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Urethra (GC) Urine is the optimal specimen for chlamydia/gc detection in males. Patient should not have urinated for at least 1 hour prior to specimen collection see Urine For urethral collection: Using blue shaft collection swab, insert swab 2 to 4 cm into urethra. Rotate swab 2 to 3 seconds to ensure adequate sampling. Place swab into transport kit, breaking shaft at indicated score line. Secure lid firmly. If suspected sexual assault/abuse, please refer to "STI (Assault/Abuse)" If suspected treatment failure, testing should be performed by culture. testing: Urine: Aptima Urine collection kit Urethra:Aptima Unisex swab kit For culture: Swab in clear transport media bag separately to Information CHLGCURINE/ Urine-Chlamydia/GC specimen can be collected for both tests. CHLURETHRA/ Urethra-Chlamydia/GC If culture collected: CUURETHRAGC / Urethra-GC (Gonorrhea) s Urethra Chlamydia trachomatis LGV Lymphogranuloma venereum Urethra Mycoplasma/ Mycoplasma hominis urealyticum Genital mycoplasmas Urine is the optimal specimen for chlamydia/gc detection in males. Patient should not have urinated for at least 1 hour prior to specimen collection -see Urine Chlamydia trachomatis. For urethral collection: Using blue shaft collection swab, insert swab 2 to 4 cm into urethra. Rotate swab 2 to 3 seconds to ensure adequate sampling. Place swab into transport kit, breaking shaft at indicated score line. Secure lid firmly. If suspected sexual assault/abuse, please refer to "STI (Assault/Abuse)" If lympogranuloma venereum (LGV) suspected, consult microbiologist Using a small, wire shaft swab, insert 2-4 cm into urethra, Rotate swab 2 to 3 seconds to ensure adequate sampling. Place into Universal Medium. testing: Urine: Aptima Urine collection kit Urethra:Aptima Unisex swab kit UTM Universal Medium for Virus bag separately to Sent to BCCDC (forwarded to NML) frozen or refrigerated CHLGCURINE/ Urine-Chlamydia/GC specimen can be collected for both tests. CHLURETHRA/ Urethra-Chlamydia/GC GENMYCOPCR/ Genital Mycoplasma/ Investigation of "genital" mycoplasmas (Mycoplasma hominis / urealyticum) Page 6 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Urethra GC urethritis Insert a small swab 2-4 cm into the urethral lumen, rotate swab and leave in place for at least 2 seconds to facilitate absorption. If purulent urethral discharge, testing for chlamydia/gonorrhea is indicated. Urethra STI (Assault/Abuse) No screening recommended for chlamydia/gc. Prophylactic treatment is best practice. Urethra (age 12 years or less) STI (Assault/Abuse) Penis C&S (Routine ) Candida Urine (GC) In age group of 13 years and younger, if a sexually transmitted disease is being investigated it is recommended that a urine specimen be submitted for testing. Positive specimens are sent to BCCDC for testing with a second set of primers. Swab of skin surface that has had no break in skin integrity. **IH Patient Collection Instructions available** Ensure patient has NOT urinated for at least one hour prior to collection. Collect 20-30 ml or a FIRST void urine into a clean container. Note: One specimen can be used for both Chlamydia and GC Cervical or vaginal swabs are preferred on adult female patients although urine samples will be accepted. testing: Urine: Aptima Urine collection kit Aptima urethral swab is also acceptable Aptima Urine Collection Kit Transfer 2mL of urine (using include plastic pipette) into the collection kit container. Ensure urine/fluid level is between the two fill lines on the transport tube. bag separately to Information CUURETHRAGC/ Urethra-GC (Gonorrhea) Effective fall 2015 - Refer to IH SAVR policy and procedure manual CHLURETHRA/ Urethra-Chlamydia/GC CUSKIN/ Wound C&S- Skin (Intact Surface) including Yeast (Candida) CHLGCURINE/ Urine-Chlamydia/GC specimen can be collected for both tests. s Page 7 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Urine Chlamydia trachomatis **IH Patient Collection Instructions Aptima Urine available** Collection Kit Ensure patient has NOT urinated for at Transfer 2mL of least one hour prior to collection. urine (using Collect 20-30 ml of a FIRST void urine include plastic into a clean container. Note: One pipette) into the specimen can be used for both collection kit Chlamydia and GC container. Ensure Cervical or vaginal swabs are preferred urine/fluid level is on adult female patients although urine between the two samples will be accepted. fill lines on the transport tube. Urine Trichomonas Urethritis, male Trichomonas Ensure patient has NOT urinated for at least one hour prior to collection. Collect 20-30 ml of a FIRST void urine into a clean container. Note: Testing requires approval of the Medical Microbiologist at BCCDC and prior testing for both Chlamydia and GC Order will be reviewed by a IH microbiologist Aptima Urine Collection Kit Transfer 2mL of urine (using include plastic pipette) into the collection kit container. Ensure urine/fluid level is between the two fill lines on the transport tube Note: Testing for females is available in IH via vaginal swab. Urine Mycoplasma/ Genital mycoplasma Collect first void urine (at least 10 ml) Sterile urine container Sent to BCCDC (forwarded to NML) frozen or refrigerated Information CHLGCURINE/ Urine-Chlamydia/GC specimen can be collected for both tests. TRICHPCR / Trichomonas Urine Trichomonas testing by molecular assay. Test is orderable by lab only. GENMYCOPCR / Genital Mycoplasma/ Investigation of "genital" mycoplasmas (Mycoplasma hominis / urealyticum) s & Mycology & Mycology Page 8 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Genital C&S (Routine ) Skin/Lesion Genital Skin/Lesion Genital Skin/Lesion Genital Skin/Lesion Special Test Order Candida/Yeast Virus Detection/ PCR () Chancroid Donovanosis Haemophilus ducreyi Herpes Virus (HSV) Varicella Virus (VSV) Swab of "intact skin" sources such as: foreskin, groin, labia, foley catheter site, penis, perineum, scrotum, urinary meatus, vulva, diaper rash. If episiotomy site swab, please refer to "Wound - Broken Skin" If abscess swab, please refer to "Wound- Abscess (Pus) Swab" Consult with microbiologist prior to specimen collection from genital ulcers / buboes. Special culturing is required. Swab of "intact skin" sources such as: foreskin, groin, labia,foley catheter site, penis, perineum, scrotum, urinary meatus,vulva, diaper rash. If episiotomy site swab, please refer to "Wound - Broken Skin" If abscess swab, please refer to "Wound- Abscess (Pus) Swab" Includes vesicular lesions on skin in genital region. Unroof the lesion with a tuberculin syringe or broken edge of a sterile swab shaft. Swab the broken blister and place swab into transport media. Alternately, the contents of the lesion may be aspirated with the syringe and transferred directly to the vile of transport medium. or fluid from bubo UTM Universal Medium for Virus Information CUSKIN/ Wound C&S- Skin (Intact Surface) including Yeast (Candida) If episiotomy site swab, please refer to "Wound - Broken Skin" If abscess swab, please refer to "Wound- Abscess (Pus) Swab" Consult microbiologist if Hemophilus ducreyi (Chanchroid) or Donovanosis suspected ST = Special Test / OM = not orderable submit to Lab with indications CUSKIN/ Wound C&S- Skin (Intact Surface) including Yeast (Candida) VIRSKIN/ Virus Detection Skin/Lesion/Wound Order includes detection of Herpes (HSV) and Varicella (VSV) viruses s Virology Requistion Page 9 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Genital Chlamydia trachomatis Skin/Lesion LGV Lymphogranuloma venereum Placenta C&S (Routine ) Group B Streptococcus Listeria Throat/Tonsil Intrauterine Device (IUD) Rectal / Anus (GC) C&S (Routine ) (GC) STI gonorrhea Consult with microbiologist prior to specimen collection, as testing requires special approval. Appropriate specimen types include urethral, vaginal or cervical swab or swab of purulent material from inguinal lymph node. Placental tissue is specimen of choice. Submit placenta tissue in small amount of sterile saline. Placenta swabs are poor specimens due to contamination from the female genital tract. Depress the tongue with a tongue depressor. Sample the posterior pharynx, tonsils, and inflamed areas. Avoid swabbing tongue or oral mucosa Note: In high risk populations such as MSM (men who have sex with men) a pharyngeal test may be collected in addition to culture. These specimens are no longer processed in Microbiology due to contamination with genital flora (Contraception 65:339-342) Insert the swab approximately one inch into the anal canal. If the swab is stained with feces, then use another swab to collect the sample. Move the swab from side to side in the anal canal to sample crypts: allow several seconds for absorption of organisms onto the swab. Note: In high risk populations such as MSM (men who have sex with men) a rectal test is recommended with or without culture. swab kit (CTGC ) Sterile screw cap container or swab in clear High risk populations: swab kit (CT/GC ) High risk populations: swab kit (CT/GC ) bag separately to Store at room temperature Store at room temperature bag separately to Information If Lymphogranuloma venereum (LGV) suspected, please contact microbiologist Tissue: CUTISSUE/ Tissue C&S Swab: CUPLACENTA/ Placenta Swab C&S. Anaerobic culture will be performed on tissue specimens. CUTHROATGC/ Throat- Gonorrhea (GC) Routine throat culture including Neisseria gonorrhoeae (GC) If Aptima () test collected CHLGCTHROAT / Throat-Chlamydia/GC CURECTALGC/ Rectal-Gonorrhea (GC) If Aptima () test collected CHLGCRECTAL / Rectal-Chlamydia/GC s If Aptima swab: If Aptima swab collected: Page 10 of 11 Genital and STI s Nov 2018
Source Test Name Names Specimen Requirements Collection Rectal / Anus Chlamydia trachomatis LGV Lymphogranuloma venereum Insert the swab approximately one inch into the anal canal. If the swab is stained with feces, then use another swab to collect the sample. Move the swab from side to side in the anal canal to sample crypts: allow several seconds for absorption of organisms onto the swab. swab kit (CTGC ) bag separately to Information CHLGCRECTAL/ Rectal-Chlamydia/GC Rectal swabs testing positive for Chlamydia trachomatis are forwarded to NML Winnipeg for Lymphogranuloma venereum (LGV) testing s Note: In high risk populations such as MSM (men who have sex with men) a rectal test is recommended as a screening test. Semen Mycoplasma/ Genital mycoplasma Semen is not an acceptable specimen source for this test. Please submit a urethral swab or first void urine. Semen C&S (Routine ) Semen is not an appropriate specimen type for bacterial culture. For detection of STI please submit urethral swab or urine for testing. Trichomonas For male testing see urine For female testing see vagina Page 11 of 11 Genital and STI s Nov 2018