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Lesion swab specimen collection kit containing a transport tube and specimen collection swabs. Whenever possible, collect all culture specimens prior to administration of any antimicrobial agents. Specimens may be hand delivered to the laboratory or transported via the runners from Technical Services if the specimens are not indicated as deliver immediately. Specimens should be in tightly sealed, leak proof containers and transported in sealable, leak-proof plastic bags. Further questions may be referred to the Microbiology laboratory (356-2591) or pathology resident (pager 4903 weekdays; pager 3404 evenings and weekends). A sterile container (37777) may be used for tissue if transported to the microbiology lab immediately (add drops of sterile saline to keep small pieces of tissue moist). Copan Liquid Amies Elution Swab (ESwab) (74541) a€“ swab specimens are suboptimal, but will be accepted if no other sample can be obtained.
Anaerobic flora is prevalent on mucosal surfaces of the oral cavity, upper respiratory, gastrointestinal, and genital tracts; specimens collected from these sites should not ordinarily be cultured for anaerobic bacteria.
Holding the applicator sponge downward, pinch wings on applicator to break ampule and release the antiseptic. Use a side-to-side motion to scrub the site with the friction pad for a full 30 sec; allow site to dry completely (at least 30 sec) before venipuncture. Remove overcaps from bottles (1 aerobic 924171 and 1 anaerobic 924172) and cleanse each rubber septum with separate 70% alcohol swabs. For adults with a suspected bloodstream infection (BSI), collect two initial sets of blood cultures sequentially from separate phlebotomy procedures followed by a third and a fourth set at 4-6 hour intervals (will detect >99% of BSIs). If patient is allergic to chlorhexidine, prep site with a povidone iodine swab stick (907172) applied in concentric circles (start at center). Pediatric – Apart from NICU patients, the minimum volume drawn should be 1 mL per year of age per blood culture set. Cerebrospinal Fluid (CSF) – Aseptically collect CSF from a lumbar puncture into sterile tubes (907131). Inner ear – Tympanocentesis should be reserved for complicated, recurrent, or chronic persistent otitis media.
Conjunctiva – Sample each eye with separate swabs (premoistened with sterile saline) by rolling over conjunctiva. Genital –Cultures for Neisseria gonorrhoeae should be collected using an Copan Liquid Amies Elution Swab (ESwab). If Nocardia is suspected, culture for Nocardia should be requested as an add-on test as standard culture is inadequate for its recovery. Transport fluid to laboratory in sterile, leak-proof container (BD Vacutainer, no additive, yellow top, 924044) or anaerobic transport vial (Vial, 59546). Amniotic and culdocentesis fluids should always be transported in an anaerobic transport vial (59546). One aerobic blood culture bottle (924171) inoculated at bedside (up to 10 mL) is highly recommended provided adequate sample is available. Surveillance cultures may be ordered on Bone Marrow transplant and other immunocompromised patients to detect overgrowth of normal flora by Staph aureus, yeast or a gram negative bacillus. Gray top C&S urine containers are not acceptable for urinalysis and urine chemistries because the preservative interferes with testing. Midstream clean catch method: Patients should be instructed to wash hands prior to collection and offered exam gloves. Female patients should be instructed to sit on toilet with legs apart and spread labia with one hand.
Skin: Using a scalpel blade, scrape the periphery of the lesion border and transport in a sterile container.
Swabs are suboptimal for recovery of mycobacteria due to limited material and the hydrophobicity of the mycobacterial cell envelope (often compromises a transfer from swabs onto media). Nasopharyngeal swab: Collect specimen using the flexible minitip flocked swab (Hospital Stores #33595). With sterile gloved hand, insert suction catheter into the patient's nose to the depth of the nasopharyngeal area (beyond the turbinates). With the non-sterile gloved hand, instill approximately 1-2 mL normal saline outside the catheter. Specimens transported by tube system must be transferred from trap to a leak-proof sterile container (be sure the lid is tightly secured).
PCR Assays are available for the following viruses: HSV1&2, VZV, enterovirus (CSF), EBV (Blood and CSF) and CMV (blood, CSF, or BAL).
HIV Viral Load by PCR, Hepatitis C Virus RNA by PCR and Hepatitis B Virus DNA by PCR: For each test collect at least 6 mL whole bold in one pink (EDTA) top tube. Neisseria gonorrhoeae & Chlamydia trachomatis Detection by PCR: Amplified DNA (PCR) testing is recommended for urine, endocervical, urethral, oral or pharyngeal and rectal swab. Endocervical, urethral, oral or pharyngeal, rectal swab: Use multicollect specimen kit available from hospital stores (46161).
Urine: The patient should not have urinated for at least one hour prior to sample collection.
Ova and parasite exam: Within 1 hour of collection, transfer a few grams of stool to each vial of SHL collection kit (Hospital Stores 923450).
Parasite exam: For direct examination of parasites (worms), arthropods (insects, spiders), and suspect material passed in stool.
Scabies exam: Sterile mineral oil is available from Pharmacy (item 991565, 10 mL container). Wet Prep for Trichomonas, Yeast or Gardnerella: Collect vaginal specimen in Affirm VPIII Collection and Transport System. Say you’re in a monogamous relationship or you’re always really, really careful when it comes to your sexual behaviour – you’re still at risk of getting an STI.
If you are a sexually active young adult living in Canada, the clear answer to this question is an unambiguous yes!
Yes, some people with common STIs can have symptoms like genital warts for HPV, lesions or blisters for genital herpes, and genital discharge and pain for chlamydia. But in many cases, a person with one of these STIs has no physical signs of the infection even though they can still transmit it. In the chart, you will see some conservative estimates, based on the scientific literature, for what percentage of young adults in their twenties are currently infected with different STIs.
Genital warts are common and often look like cauliflower-shaped growths or small hard lumps or skin tags.
Once the warts are gone, you may still be infectious for some time until your body clears the virus. Because some types of HPV can lead to cervical cancer, it is important for women to get regular Pap tests to detect any abnormal changes in the cells of your cervix. HPV is very common and you can carry and transmit an asymptomatic HPV infection long after you get it. HSV is one of the most common STIs there is, and once you have the virus, it will stay with you even when you aren’t having an outbreak.
Most HSV-2 infections, referred to as genital herpes, are the result of genital-to-genital contact.
If you get infected, you may or may not have outbreaks, which are small painful blisters in the genital area. If you think you are having a first outbreak, it’s important that you see a doctor immediately. Most genital herpes infections don’t show any symptoms, so the infected person doesn’t know it’s there, but they can still transmit the virus.
Common among teenagers and young adults in their 20s, chlamydia is easy to treat once detected. Many people think that if they got chlamydia they would know it – that there would be some kind of unpleasant discharge or that it would hurt to urinate. If left untreated, chlamydia can cause pelvic inflammatory disease, tubal infertility, chronic pelvic pain, ectopic pregnancy, and make you more susceptible to contracting HIV. Chlamydia is actually quite easy to treat if it’s caught early, before doing any major damage to your reproductive system. Gonorrhea may not be as common as some other STIs, but if you have unprotected sex with someone who has it, there is a good chance you will be infected. Gonorrhea is very similar to chlamydia in that they are both bacterial infections and share comparable symptoms. One major difference between the two is that symptoms often show up more quickly, sometimes within a few days.
Gonorrhea can have profound negative health consequences, particularly for women, when not treated promptly.
If you have unprotected sex with an infected person, the chances that you will be infected are quite high. Most people infected with HBV will be left with few, if any, lasting health consequences; however, a small percentage of people can suffer significant liver damage as a result of the infection. HBV is transmitted when infected saliva, blood, vaginal fluid, or semen (come) enters the blood stream. Hepatitis B has become less common in Canada in recent years, partly because many people have been vaccinated against it. If you have not been vaccinated against HBV and think you may be at risk, you should get tested for the virus and consider being vaccinated. Human immunodeficiency virus (HIV), the cause of acquired immunodeficiency syndrome (AIDS) doesn’t get as much attention as it used to. Soon after a person has been infected with HIV they may experience flu-like symptoms, such as a fever or sore throat. As the HIV-infected person begins to develop AIDS, a number of symptoms and conditions may occur. If you’re sexually active, getting tested for STIs is definitely a good idea, especially if you have had sex without a condom. If you are a sexually active woman, you should receive Pap testing (to detect abnormal changes to your cervix caused by HPV infection) as a regular part of your health care. The first thing you should know is that college and university health services and walk-in medical clinics do STI tests all the time. Testing for chlamydia is pretty straightforward: a small swab is used to take a sample from the woman’s cervix or the opening of the man’s penis. Most HPV infections have no visible symptoms, so without visible genital warts, it’s very difficult to tell if you have HPV.


The HIV test – also known as the AIDS test – is a blood test that determines if you have been infected with HIV. It takes three months after you have been infected with HIV for a blood test to detect HIV antibodies in your system. It will take 1 to 3 weeks for the results to come back and you will have to get them in-person.
Any physical contact between people brings some risk of disease or infection – the same is true of sexual contact and STIs.
Having a plan means you’ve thought about your future, where you’re going, and what you need to do along the way. Many people even plan out things like what kind of relationship they want or when in their life they’d like to get married. It’s sitting down and deciding what you do and don’t want to do sexually over the short, medium and long-term.
If you don’t have an answer that rolls off your tongue maybe you should sit down and think about it. Condoms: easy to use, easy to buy – and they are very effective in preventing STI transmission and pregnancy. Consistently using latex, polyurethane or polyisoprene condoms is very effective in significantly reducing your risk of transmitting or becoming infected with an STI. Laboratory tests have shown that latex, polyurethane or polyisoprene condoms block particles the size of HIV, HPV, HSV, chlamydia, and gonorrhea.
Also, if used correctly condoms are very effective in preventing pregnancy, making them one of the most effective contraceptives available.
Let’s be clear: sex with condoms is not 100% risk free, but if you use condoms your STI risk will be much lower. Some people might feel a little awkward or embarrassed about talking about condoms with their partner.
Maybe it’s as simple as whispering to partner: “I always use condoms” or “I’ve got condoms”. However you bring it up, it’s a good idea to plan out in advance when you will bring it up.
Probably at some point before or soon after physical contact has begun but before clothes start to come off is best. If your partner seems reluctant the first thing you can say is “I want to be with you, but condoms are part of the package when you sleep with me”.
Especially if this is a first time partner, and you are still getting push back, it’s time to think about showing them the door. Tip: If you’re worried about losing an erection, don’t put the condom on while lying on your back – it’s easier for the blood to flow out of the penis. The pill is a great method of birth control, but it does absolutely nothing in the way of protecting you against getting an STI. Sometimes as two people become a couple they decide to use the oral contraceptive pill to prevent pregnancy. If you’ve just gotten your prescription for the pill you can say to your partner, “I’m glad to be on the pill now.
If your partner doesn’t understand why you want to use condoms while you are on the pill or is pressuring you not to use condoms, you can say, “My doctor told me to keep using them. You’ve got many, many options when it comes to condom shopping – and picking out a few new ones to try is only half the fun.
Condoms come in different shapes, sizes, textures and colours with a variety of lubricants for enhanced sensation. You definitely want to choose a condom that’s made with high quality materials that effectively block sperm and STIs, which means it needs to be made of either latex or polyurethane.
If you have a latex allergy, and lots of people do, then polyurethane condoms are definitely your answer. Using a condom is simple – BUT incorrect usage can lead to condom slippage or breakage, which reduces their effectiveness! Immediately after ejaculation, hold the condom in place and withdraw the penis while it is still erect to avoid spilling semen. There are some persons who depend on outward signs to determine whether or not they have herpes; however, infected persons do not always show symptoms, and herpes shedding can still occur, which causes the virus to be transferred from person to person. The herpes simplex blood test is the most common type of herpes testing, especially when there are no outwards signs of the disease. As stated earlier, if you or your partner were recently exposed to the virus, you may end up with false negatives; furthermore, a majority of blood tests for herpes do not test specifically for HSV-1 or HSV- 2. The Western Blot Test is a herpes blood test that is type specific, which is being performed by a majority of labs.
Once you have a positive herpes blood test, you should consult with your doctor so that treatment can be started immediately. 8x upper limit of normal ALT usually elevated >AST ALKP modestly elevated Bilirubin normal to highly elevated –These are quick tests if you suspect hepatitis. Lab Findings ALT usually >8x upper limit of normal ALT usually elevated >AST ALKP modestly elevated Bilirubin normal to highly elevated –These are quick tests if you suspect hepatitis. Hepatitis A Serology HAV IgM – rises early in illness, will remain positive for up to six months. Hepatitis B Serology HBsAg: First evidence of infection, persists through clinical illness. Hepatitis C Serology Positive Anti-HCV EIA needs confirmation HCV RIBA (Recombinant Immunoblot Assay) confirms + EIA.
The following is a list of specimens that are likely to be contaminated with anaerobic normal flora and are NOT routinely accepted for anaerobic culture.
For intact eardrum, clean ear canal with soap solution and collect fluid via syringe aspiration.
If blood culture bottle is inoculated, submit separate aliquot in anaerobic transport vial (59546) or sterile container (37777) for preparation of cytocentrifuged Gram stain and inoculation of solid media (allows quantitation, aids in culture interpretation).
Specimens for mycobacteria should be double bagged and sent sealed in leak-proof containers. Measure the distance from the patienta€™s nostril to the nasopharynx (half the distance from nostril to base of the ear) and hold the swab at that location. With specimen trap still in-line, rinse catheter with remaining saline to clear secretions. PCR testing requires a dedicated collection tube and cannot be added onto a previously opened vacutainer tube. Submit vesicle fluid, surface swab, or BAL (sputum and tracheal aspirates are unacceptable) in UTM media. Touch the perianal folds with clear scotch tape, then attach the tape to a clean glass slide and transport to the laboratory sealed in a ziplock bag. Even if you consider yourself to be conservative and cautious when it comes to sexual behaviour, you may be at higher risk for STIs than you think. In fact, most cases of HPV, genital herpes, and chlamydia transmission involve a person with an asymptomatic infection passing it to an uninfected partner. This section provides some basic information on the most common STIs and what the implications for your health are. For example, it is estimated that up to 40% of sexually active young women may be infected with an STI by age 191 and up to 10.5% of people will have been infected with genital herpes by age 302.
Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States.
They can appear anywhere in the genital and rectal areas but can be very hard to see, so people often have them without knowing.
If the Pap test detects these changes, doctors can treat it by removing the tissue well before it becomes cervical cancer.
Although most people have been exposed to HISV-1 only a minority of people end up getting cold sores. If you are infected, but have no outbreaks, you can still transmit the virus to other people. Treatments like acyclovir, valacyclovir, and famciclovir have been developed which can shorten or stop outbreaks and reduce the chances of sexual transmission, but the virus will still remain.
In addition to the blisters or sores, an initial outbreak often includes fever, swollen lymph nodes, headaches, fatigue, and muscle aches.
Don’t wait around to see if the sores go away – quick treatment will reduce the length of the outbreak. However, these symptoms don’t usually show up until 1 to 3 weeks after you’ve been infected. These negative outcomes include Pelvic Inflammatory Disease (PID), ectopic pregnancy, and infertility. Since a high proportion of people who have gonorrhea also have chlamydia, it’s likely you’ll also be tested for chlamydia if you have symptoms for gonorrhea.
So, if a current or past sexual partner informs you that they have been diagnosed with gonorrhea, it’s very important that you get tested and treatment right away.
When symptoms do show, they include: vomiting, flu-like symptoms, fatigue, loss of appetite, and yellowing of the skin and eyes.
It’s likely that condoms reduce the risk of transmission because HBV sized viruses are too big to pass through latex, polyurethane or polyisoprene condoms.
Still, over 65,000 Canadians have tested positive for HIV, there are about 2,500 new HIV infections each year, and it is estimated that over a quarter of people with HIV in Canada don’t know they have it.
These symptoms will disappear and the person may have no further symptoms of the infection for up to 10 years or longer. So far, the most effective treatment is a combination of drugs called highly active antiretroviral therapy (HAART). If used consistently, latex, polyurethane or polyisoprene condoms are very effective in preventing HIV infection. It’s a routine, everyday thing for them so don’t hesitate to call to make an appointment or walk into the clinic to ask for STI testing. You will likely be asked some straightforward questions beginning with why you would like STI testing. Symptoms or no symptoms, be prepared to be asked some questions about your sexual behaviour so that the doctor or nurse will be able to determine if STI testing is appropriate and which tests to conduct. Yes, you may be asked some questions you’re not used to being asked, especially by strangers, but at the end of the day the most important thing is to get it checked out and, if necessary, properly diagnosed and treated so you can get on with your life.
Most cases have no symptoms, but if left untreated, can cause serious damage to your reproductive system.


Using a swab, a sample is taken from the sore or blister and sent to a lab for a viral culture test which will determine whether it is HSV-1 (the cold sore virus) or HSV-2 (the genital herpes virus) or neither. Since most HPV infections clear on their own over time, the need for developing an HPV test has not been a priority. If you test positive for the virus, you will need to have further blood tests to see if it has damaged your liver.
The test does not identify the virus itself but rather detects if your body has produced antibodies to the virus.
So if you had unprotected sex a few days ago you are going to have to wait a couple of months before to be able to tell if you have been infected. There is a Rapid Test for HIV that some clinics offer that will give you the results right away. With a confidential test, the results are included in your medical file and only medical and health professionals, like the local medical officer of health are allowed to see unless you give written permission for them to share it with someone else.
Giving precise estimates of the likelihood of contracting an STI from an infected partner as a result of sexual activity is, in most cases, impossible; in other words, it’s not an exact science. It should be used as an approximate guide to comparing the relative STI risks of different sexual acts. But think about it: many of us plan out important parts of our life whether it’s financial and educational goals or things like physical fitness. It’s about deciding what’s right for you when it comes to sex and once you’ve done that you won’t have to make spur of the moment decisions about sex, which can be fueled by lust, alcohol, drugs, or emotions. The only things more effective than condoms in reducing STI risk are to not have sex at all or to make sure that both you and your partner(s) are STI free – although that’s very difficult to do with absolute certainty. And, studies comparing people who use condoms consistently with people who don’t use condoms during sex have found that consistent condom use reduces the risk of contracting HIV, HSV, HPV, chlamydia and gonorrhea.
The bottom line is that if you are a sexually active young adult, whether you are single or in a relationship, whether you have sex once in a while or every night, using condoms will reduce your risk of STI.
Talking about condoms doesn’t have to break the mood, in fact it can put both partners at ease – now you both know sex is going to happen and it’s going to be protected.
If your partner doesn’t want to use condoms with you they probably tried to talk their way out of using them with previous partners. The pill isn’t perfect and either of us could pass on an STI that we didn’t even know we had. Fortunately, because latex, polyurethane and polyisoprene condoms are quite flexible and are designed to be “form-fitting”, fit is not a problem in most cases. Most of us are familiar with latex condoms so if you haven’t seen or touched a polyurethane condom, check it out. Take the time to read this section so you know you’re doing everything you can to stay safe! Lesions, pre-ejaculate secretions, semen, vaginal secretions and blood can all transmit infectious organisms. Be sure the rolled up ring is on the outside and leave space at the tip to hold semen when you ejaculate. You can check to see if you have herpes by doing a cell culture test, or by doing a herpes blood test. Blood will be drawn from you, and then it will be tested to see if there are any herpes antibodies present. Although these tests are quite effective in testing for herpes, they are not type specific. Marker of infection or inflammation Nitrite: Urine nitrates are converted to nitrite by some bacteria (E. So, –If someone has a positive HAV Total and an positive HAV IgM, they have a current infection. Use needle and syringe to aseptically collect 4 mL freshly voided urine though catheter port. Use needle and syringe to aseptically collectA  A 20 mL freshly voided urine though catheter port. Using sterile technique, insert a double catheter into the cleansed stoma, to a depth beyond the fascial level, and collect the urine into a sterile container.
The lab only accepts Copan Liquid Amies Elution Swab (ESwab) for AFB culture when the ordering physician confirms that the swab is the only possible way to obtain the specimen. Each test requires a dedicated collection tube and cannot be added onto a previously opened vacutainer tube.
After collection, specimens may be stored and transported at 2 to 30 A?C for up to 14 days.
These infections can have some serious implications for your health and well-being so this is something you should definitely pay attention to. You may be surprised to learn that many individual cases of STI have no symptoms right away or at the moment of contact. Even if you have only had a couple of sexual partners in your lifetime, there is a high probability that you have had sex with someone who has an STI.
Seroprevalence of herpes simplex virus type 2 among persons aged 14-49 years, United States, 2005-2008. HSV-1 can also infect the genital area, such as when a person shedding HSV-1 from their lips transmits to their partner’s genitals during oral sex. Some people with chlamydia have no signs or symptoms of the infection so they can transmit the infection to their sex partners without knowing it. If you are treated it is important that your partner is too or else they’ll just give it back to you or to someone else.
Using latex, polyurethane or polyisoprene condoms reduces the chances you will be infected.
During this time when a person has no symptoms, he or she can still transmit the virus to other people.
As AIDS progresses, the person’s immune system is weakened and increasingly unable to fight off some types of disease. HAART has been effective in significantly extending the life-span of people living with HIV.
The good news is that most colleges and universities have student health services where you can get tested for STIs. If you tell the doctor or nurse that you have symptoms, like sores or bumps on your genitals or an unusual discharge, they will want to look at your genital area. If you think you have contracted a particular STI you need to tell the doctor or nurse which one.
It’s very important that your partner is tested and treated so that you do not pass the infection back and forth. Testing is similar to the testing for chlamydia: a swab is used to take a sample from the cervix or penis opening. There is a DNA test for HPV but it is only used as a follow-up procedure for women over 30 years of age with abnormal Pap test results.
However, if the rapid test is positive, you will need to have the regular test in order to confirm the results. However, if you apply for insurance you will need to supply your medical file, which will include your HIV test results. If you want to get an HIV test and want it to be anonymous check with local clinics in your area to see if they offer it.
For example, the chart indicates that using a condom during intercourse is “lower risk” for various STIs than having intercourse without a condom. Maybe that’s why so many people end up with STIs or wake up the next morning regretting the night before. By bringing up the topic of condom use you are sending a loud and clear signal to someone you are interested in: yes, you want to have sex and yes you’re smart enough to take care of your sexual health. If your partner is someone you have been getting to know for a while and this is the first time you’re going to have sex, you can say something like “I saw these at the student health centre.
By that time, it’s all about passion and pleasure and it’s much easier to forget or put it out of your mind, especially if you’ve had a few drinks.
By now you should know how common STIs with no symptoms are and be thinking that continuing to use condoms is a good idea. But if you or your partner are particular, there are many different shapes and sizes to choose from. The material isn’t quite as flexible as latex, but polyurethane is thinner and transfers heat more easily.
Or pick up a few different kinds and have some fun testing them until you find the one that’s just right for the two of you. Herpes blood test accuracy is very high for long term; however, if you or your partner were recently exposed to the virus, the test may produce false negative results. There are type specific blood tests that you can take to determine whether you have contracted HSV-1, or whether you have contracted HSV-2.
Just as with the Western Blot Test, if you show no outward symptoms, you should wait 2 weeks before performing the test. Gently insert the swab along the base of one nostril (straight back, not upwards) and continue along the floor of the nasal passage until reaching the nasopharynx. Preliminary slide results will be available within 90 minutes if specimen received between 0700-1900 or by 0930 if after 1900.
The doctor may apply a white vinegar solution: if the growths turn white it is an indication that they are genital warts.
It can take anywhere from 2 weeks to 3 months for the herpes antibodies to be shown in your system; as such, your doctor may recommend that you take a swab sample in addition to the herpes blood test. It is recommended that if you show no outward signs, you should wait at least 2 weeks after exposure to have this test done. Onset of diarrhea in patients hospitalized for >3 days is usually not attributed to a parasitic infection. If clinical suspicion for malaria remains after one set of negative smears, additional specimens should be submitted at 12 hour intervals for the subsequent 36 hour period. If the HIV infection has progressed to full blown AIDS, the person usually dies within a few years. Pap tests, which women should be getting regularly, are designed to detect cervical abnormalities that are usually caused by an HPV infection of the cervix.



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