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STI Labs

Gynecology

QuestionAnswer
Wet prep swab cotton swab; rotate over vaginal wall/inflammation; avoid cervical mucus/blood; in 1 mL saline
Wet prep spec to lab within: 20 min (in 1 mL saline)
Cervical testing no bathe 24 hrs; unlubricated speculum; remove cerv mucus w/cotton swab; sterile swab into canal 15-30 sec; plate or media
Gono cx plates TM, choc, or Jembec (CO2 reservoir); swab in Z pattern & cross streak; 36C (don’t refrigerate)
Gram stain urethra: Ca alginate 1-2 cm x 3-5 sec (females more shallow); cervic: cotton swab, usu not done (gold std for clue cells)
Oropharyngeal NG cx swab posterior pharynx & tonsillar crypts; include areas of inflammation or exudate
Urethral NG cx Collect ≥1 hr post urination; ideal: prior to first morning micturition; swab anterior urethra
HSV cx collection Unroof vesicle lesion (18 ga needle), abrade w/cotton swab; crusted: remove crust w/moist gauze, scrape w/cotton swab; transport medium, refrigerate if delay
HSV serology less sensitive; helpful if IgM or high IgG
4-fold rise in HSV titer indicates: acute initial HSV infxn
Darkfield for syphilis pos = diagnostic; not definitive if neg
Syphilis: nontreponemal tests RPR more sensitive than VDRL; VDRL positive 2 weeks after inoculation, positive thru secondary and often in tertiary
All syphilis tests 100% sensitive in stage: secondary
Syphilis: treponemal test FTA; more specific, pos 4-6 weeks post inoculation; FTA-Abs (sandwich): more sensitive = definitive test; MHA-TP
NG tests gram stain, cx (specify suspicion), NAAT (DNA by PCR)
Chancroid: cofactor in contracting: HIV
Chancroid tests cx (specify suspicion), DNA PCR, no serology
Chlamydia tests Lipase chain reaction (LCR) most sensitive/specific. Direct fluoro Ab. NAAT (DNA by PCR). Cx & serology outdated
HIV requirement: Patient must be informed of HIV testing; informed consent/ counseling no longer required nationally
HIV Detuned testing both sensitive & low-sensitivity tests; if only 1 is pos = recent infxn
HIV p24 test free antigen or bound antigen/Ab complexes; detectable 2-6 weeks post infection
HIV p24 to dx: viral Rx, neonatal infxn, detect HIV before seroconversion, dz progression
HIV viral load reflects Rx response better than CD4; detects transplacental transmission
LGV test complement fixation
GN bipolar rods encapsulated in mononuclear lymphs = Granuloma inguinale (donovan bodies)
Gold standard for HSV testing Viral culture.
In HSV, Tzanck smear reveals: multinucleated giant cells
CSF for neurosyphilis Unreliable to exclude Dx of syphilis, but useful to document resolution after tx
Created by: Abarnard