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STI Labs
Gynecology
| Question | Answer |
|---|---|
| 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 Cx & serology outdated |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
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