Vaginal Swabs (OSCE)

Introduction 

1. Greet patient and introduce yourself 
2. Explain the procedure in a patient friendly manner 
3. Explain that a chaperone will be present throughout the procedure and why 
4. Get patient consent ✅ 
5. Check the patient is not in any pain or pregnant 🤰
6. Ask patient to remove underwear whilst you leave the room, and cover themselves with the sheet provided 

Equipment  

 Disposable gloves ✋ 

 Paper towels 

 Lubricant 

 Speculum and light 

 High vaginal swab in charcoal 

 Endocervical swab in charcoal 

 Endocervical nucleic acid amplification test (NAAT) 

Inspection of the vulva 

Inspection: 

1. Don gloves ✋ 
2. Ask patient to lie in the supine position then move their heels to their bottom, relaxing their knees so that they fall outwards 
3. Assess the vulva to identify abnormalities 

 Scars: indicate prior surgery or lichen sclerosus 

 Masses: indicates Bartholin’s cyst or vulval malignancy 

 Ulcers: indicate genital herpes 

 Varicosities: varicose veins due to pelvic obstruction (e.g. malignancy) or chronic venous disease 

 White lesions: patchy, surrounding vulva or anus, indicates lichen sclerosus 

 Vaginal atrophy: typically present in post-menopausal women 

 Abnormal vaginal discharge: indicates bacterial vaginosis, candidiasis, chlamydia or gonorrhoea  

Insert the speculum:  

1. Get consent to insert speculum again ✅ 
2. Separate labia using left hand ✋ 
3. Insert the speculum gently, with it oriented sideways 
4. Once it is inserted, rotate it 90° 📐
5. Open blades to obtain optimum visualisation of the cervix  
6. Fix the blades at this position by tightening the locking nut 

Cervix visualisation 

Inspect the cervix: 

 Masses: indicate cervical malignancy 

 Ulcers: indicate genital herpes 

 Open cervical os: indicates inevitable/incomplete miscarriage  

 Erosion surround os: indicates ectropion or early cervical cancer 

 Abnormal discharge: indicates trichomonas, bacterial vaginosis, candidiasis, chlamydia or gonorrhoea 

Vaginal Swabs 

Technique: 

1. Remove lid of swab sample tube 
2. Use swab to take relevant samples 
3. Put used swab back in its tube and put the lid back on 
4. Place tube in tray 

Should I take double or triple swabs ❓ 

 This depends on local guidelines ❗ 

 Double: Endocervical nucleic acid amplification test (NAAT) and high vaginal swab in charcoal 

 Triple: Endocervical nucleic acid amplification test (NAAT) and high vaginal swab in charcoal and Endocervical swab in charcoal 

First: Endocervical nucleic acid amplification test (NAAT): 

1. Use the cleaning swab to remove excess mucous from the cervix to allow better visualisation of the external os 
2. Insert testing swab 5mm into endocervix 
3. Rotate swab for 10 to 15 seconds ⌛
4. Remove swab from cervix, break it at the score line and put it in transport tube 
5. Put lid back on sample 

 Detects: chlamydia and gonorrhoea 

Second: endocervical swab in charcoal: 

1. Insert testing swab 5mm into endocervix 
2. Rotate swab for 10 to 15 seconds ⌛
3. Remove swab from endocervix, break it at the score line and put it in transport tube 
4. Put lid back on sample 

 Detects: gonorrhoea 

Third: high vaginal swab in charcoal: 

1. Insert swab into posterior fornix (discharge pools here) 
2. Rotate swab for 10 seconds ⌛
3. Remove swab from posterior fornix, break it at score line and put it in sample tube 
4. Put lid back on sample 

 Detects: candida, bacterial vaginosis, trichomonas vaginalis, group B streptococcus 

Speculum removal 

1. Loosen locking nut 
2. Close blades slightly 
3. Rotate speculum 90° (inspect vaginal walls simultaneously) 📐
4. Use sheet to cover patient 
5. Tell patient the examination is complete and you will leave the room to allow them to change ✅ 
6. Appropriately dispose of waste 🗑
7. Wash hands ✋ 

Completion 

1. Label samples appropriately ✍ 
2. Thank patient 
3. Inform patient they will receive results via method requested 
4. Document procedure ✍ 
5. Send swabs to the lab to process 

Summary:

1. Greet the patient and explain the procedure
2. Inspect the vulva to identify any abnormalities
3. Insert the speculum into the vagina and fix it into place by tightening the locking nut
4. Inspect the cervix to identify any abnormalities
5. Take double or triple vaginal swabs, depending on local guidelines
6. Remove speculum by loosening locking nut, closing blades and rotating it
7. Complete procedure by thanking patient and sending swabs to lab