Vaginal Swabs – OSCE Guide

geekymedics.com/vaginal-swabs-osce-guide

August 25, 2018

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
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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:

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 “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

Inspect the vulva

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2. 2

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

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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

Once inserted rotate the speculum back 90 degrees

Open the speculum blades gently to obtain optimal view of the cervix

Fix the position of the speculum using the locking nut

1. 1
2. 2
3. 3
4. 4

Visualising the cervix

Inspect the cervix

Cervicitis (e.g. gonorrhoea or chlamydia)
Cervical erosions (e.g. ectropion)
Masses (e.g. cervical malignancy)
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 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
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 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

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5. Dispose of the speculum and gloves

6. Wash hands

Loosen the locking nut

Gently remove the speculum, with the blades partly closed, inspecting the vaginal
walls as you do so

Dispose of your equipment into an appropriate clinical waste bin

Wash hands.

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2. 2
3. 3
4. 4

To complete the procedure…

Thank the patient
Offer them some tissue to clean themselves
Allow the patient time to get re-dressed
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 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

Bimanual vaginal examination
Abdominal examination

Assessment
0%

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