Introduction
Gonorrhoea is the most common sexually transmitted bacterial infection spread through vaginal, oral, or anal sex with an infected person. The Centers for Disease Control and Prevention (CDC) recommend yearly gonorrhea tests for all sexually active women younger than 25 years and older women with risk factors.
Definition
Gonorrhea test is performed to identify Neisseria gonorrhoeae infection through a urine sample or a swab from the potential infected site. It is interpreted as positive or negative.
Purposes
- To aid in diagnosis of gonorrhea.
- As a screening protocol for sexually active women.
Indications
- Genital infections with a history of;
- Unsafe sex.
- Multiple sex partners.
- Previous STDs.
- Sexual exposure to infected partner.
Articles
| Articles | Purpose |
| For testing via urine sample; | |
| Sterile labeled specimen container | To collect the first part of the urine specimen. |
| For testing via swab method; | |
| Vaginal speculum | To inspect the vagina. |
| Lubricant | To aid in insertion of the speculum. |
| Sterile gauze | To wipe the secretions. |
| Soft brush or plastic spatula | |
| Nucleic acid amplification test (NAAT) swabs (vulvovaginal or endocervical) | For collecting the specimens. |
| Light source | For insertion of the speculum for visualization. |
| Sterile gloves | For aseptic precautions. |
| Drape sheet | To expose the needed or particular site. |
Procedure for cervical/vaginal swab collection
| Nursing Action | Rationale | |
| 1. | Explain procedure to the patient. | Allays anxiety and obtains cooperation from the patient. |
| 2. | Obtain informed consent from the patient. | Serves as legal evidence. Prevents litigation of the staff. |
| 3. | Arrange all articles and ensure adequate lighting in the area. | General preparation for the procedure. |
| 4. | Provide privacy and instruct the patient to remove her underwear. | |
| 5. | Perform hand wash and don clean gloves. | To prevent cross-infection. |
| 6. | Position the patient in a modified lithotomy position. | For easy visualization. |
| 7. | Drape the patient and expose only the needed part. | To provide privacy. |
| 8. | Inspect the vulva before the procedure and doff the glove. | To assess for vulva abnormalities. |
| 9. | Wear sterile gloves. | To prevent cross-infection. |
| 10. | Spread the labia with the index finger and thumb of the left hand; lubricate and insert the warmed speculum gently into the vagina (blades closed, angled downward), and once inserted rotate the blade 90° so that the handle is facing upward; slowly open the blades and lock them. | For clear visualization of the cervix. |
| 11. | Inspect the cervix and vagina. | To assess for cervical and vaginal abnormalities. |
| 12. | Endocervical Insert the swab through the speculum to the cervical os, and rotate the end to two to three revolutions 10-15 seconds in the endocervix. Vulvovagina Insert the swab through the speculum to the posterior fornix of the vagina. | Allows the cotton tip to pick up the adequate load of cells. |
| 13. | Withdraw the swab and insert it into the NAAT test tube. | |
| 14. | With the nondominant hand, hold the blades of the speculum, while unlocking it with the dominant hand. | To ensure that the blades do not snap shut when the lock is loosened. |
| 15. | Dispose of PPE and label the samples. | To prevent the transmission of infection. |
| 16. | Follow safety guidelines while handling the samples and the samples should be handled as a biohazard. | |
| 17. | Replace the articles and perform hand wash. | |
| 18. | Instruct the woman that it is normal to have a light bleeding or vaginal discharge. | To understand the changes and allay anxiety. |
| 19. | Document the name, date, and time of the procedure, indication for the procedure, and type of specimen collected. | For further planning of care. |
Special Considerations
- May be acceptable for vaginal or rectal samples, improving privacy and access.
- Adapt screening based on sexual practices and anatomy, not just gender identity.
- Always consider rectal and pharyngeal sites in patients with relevant exposure, even if asymptomatic.
- Children or Abuse Cases: Use culture-based testing for legal admissibility; follow child protection protocols.
- Transgender & Gender Diverse Individuals: Tailor screening to anatomical exposure, not gender identity.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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