Lab Rounds

August 31st 2006Nadim J Lalani

Case 1

20 yo F presents to ED c/o abnormal vaginal discharge and dysuria.

What swab do you want to send? How do you swab?

Chlamydia and Gonorrhea

Used to culture for Chlamydia/GC Chlam difficult to grow This evolved into fluorescein-

conjugated monoclonal antibody test Inc sens and spec Current Standard is NAAT (nucleic

acid amplification test) Sens approx 92%

Gen-Probe® APTIMA® Swab Very sophisticated Combines: Target Capture (finds target NA) Transcription Mediated Amplification (uses

ribosome to amplify target NA) Dual Kinetic Assay (luminescent ss DNA

probes bind to RNA and “light up”) Allows detection of both organisms Costs twice as much

Gen-Probe® APTIMA® Unisex Swab

Two swabs:”white trash””blue bottle” Male no urination w/ in 1h Female >35 not routine Request culture in

medico-legal cases

Case 2

28 yo M got a phone call from a partner who said that he should get tested for Chlamydia

Says “hell no” for swab How can you test?

First Catch Urine (FCU) NO cleaning No pee w/ in 1h Less sensitive than

endocervical/urethral (80-85%)

Need 20-30ml (draw black line)

NO MORE NO LESS!!

(Affects Sens)

Case 3

28 yo F presents with Bartholin’s abscess.

You do an I & D, but want to send a swab for C & S / anaerobes

Which ones will you use?

Bacterial Swabs - aerobes Blue Top replaced Use Red top Specify what

you’re looking for

Bacterial Swabs - anaerobes AnO2’s don’t

survive in regular transport media

Use anaerobic swab

What about the charcoal swab?

Being phased out Only if can’t find

others Specify what you’re

looking for

What if Trichomonas? Use Red Top

What if Bacterial Vaginosis?

Use Red Top

What if Candida?

Use Red Top

What about IUD’s Use sterile

container Automatically test

for Actinomyces and Ano2’s

Summary: Gono/Chlam Gen Probe Can do urine Others Red top

References

Rosen 2k6 CLS website:http://www.calgarylabservices.com/

LabTests/ http://www.cicatelli.org/IPP/

downloadable/ChlamydiaTestingTechnologies072004.pdf#search=%22NAAT%20for%20chlamydia%22