Swabbing for bacterial STIs

Most chlamydia and gonorrhea infections in Ontario are being missed during sexual health screenings because of swabbing errors. There are two major culprits: healthcare providers not prompting patients to get rectal and pharyngeal swabs and errors when patients collect their own swab samples. As we know, bacterial infections can be localized, which can lead to oral and rectal infections going undetected if only a urine sample is collected.  

Anyone engaging in oral or anal sex should take swab samples as part of their routine STI tests, although it’s worth noting that not all patients are comfortable discussing the specifics of the sex they’re having with their healthcare providers. It is worth being proactive with your clients to ask them about the kinds of sex they’re having and being clear that this has implications on the kinds of tests they should do. Asking them if they ever top (penetrative partner) or bottom (receptive partner) can be a straightforward way to let them know that they can be open with you about the types of sex they’re having. 

An increasing number of clinicians are having patients collect their own swab samples, creating room for error. Providing clear instructions to all new clients can be helpful, even if they say that they have done their own swabs before. It is better to remind them of good practice than to have the samples return unprocessed from the lab. 

Changes in Swab Kits

It’s worth noting that some of the swab test kits in Ontario have changed. These kits contain two swabs in each package: a flocked swab and a woven swab. Flocked swabs are effective for collecting cervical samples, while labs in Ontario will only process pharyngeal and rectal samples collected on a woven swab. If your kits have both swabs, tell your client to dispose of the flocked swab when they open the kit to avoid errors. 

As a reminder, pharyngeal swabs should avoid touching the teeth, cheeks, and tongue—being coated only with saliva from the back of the throat. And rectal swabs should only be inserted a maximum of one inch into the rectum to collect the mucous sample. 

A New Resource for Community Members

In order to help members of the community understand the specifics of self-swabbing, the GMSH worked with sexual health educator Bobby Box to produce an instructional video (below) and a thorough explanation of the swabbing process posted at TheSexYouWant.ca/Swabbing. This video and written resource can also be shared with your clients as needed.