Until about 3-4 years ago, I obtained swabs from the endocervix for the diagnosis of chlamydia and gonorrhea. In women with symptoms of vaginitis, swabs were obtained from the lateral vaginal walls for bacterial vaginosis, trichomonas and yeast.Cognitive learning theory in the classroom I called them the “big 5” when I explained to the patient what we were testing for (see attachment 1: stds and infections tested for with the 3 vaginal swabs, and attachment 2: testing for stds).Cognitive learning theory in the classroom

For the endocervical swabs, I used the COBAS PCR female swab sample package, and for the lateral vaginal wall, the COPAN M40 sample package. The swabs were then transported to the lab, where nuclear acid amplification testing (NAAT) was performed (NAAT has the best overall sensitivity and specificity for the diagnosis of chlamydia and gonorrhea).Cognitive learning theory in the classroom

I noticed in the back of the COBAS swab a set of instructions for self-collection and handling. I came across a publication in the british medical journal by sarah A.Cognitive learning theory in the classroom schoeman: assessment of best single sample for finding chlamydia in women with and without symptoms: a diagnostic test study 1. Participants took a vaginal swab before a routine gynecological exam, and clinicians then took an endocervical swab during examination.Cognitive learning theory in the classroom

Of the 3867 participants with complete results, 10.2% were infected with chlamydia. Self-collected vulvovaginal swabs were significantly more sensitive than endocervical swabs (97% vs 88%; P<.00001) and had equal septicity (99.9% vs 100%).Cognitive learning theory in the classroom in women with symptoms of a sexually transmitted infection (STI) or vaginitis, the sensitivity was 97% vs 88% ( P<.0008); in those with no symptoms, the sensitivity was 97% vs 89% ( P<.002).Cognitive learning theory in the classroom in those with symptoms, using endocervical samples rather than vaginal swabs would have missed 9% of infections, or 1 in every 11 cases of chlamydia in this study.Cognitive learning theory in the classroom

My personal interpretation of why the self-administered vaginal swabs (SAVS) are better than the physician administered ones is that the swabs should be in contact against the vaginal walls or the cervix for 30 seconds, and by watching the residents perform them in my office, most just touch the vaginal walls or the cervix for 5 seconds or so.Cognitive learning theory in the classroom and when they do an endocervical swab, they often don’t remove the cervical mucus (there are 2 Q-tips in the sample kit, one for mucous removal, one for sampling).Cognitive learning theory in the classroom the mucus is rich in antibodies, and less likely to test positive.

I then reviewed some of the literature on the self-collection for the other STI’s and vaginitis, and they all revealed at least an equivalent but often better detection rate with the SAVS than the physician performed swabs 2,3,4.Cognitive learning theory in the classroom in terms of patient’s preference, 90% of women found it very easy to self-collect a vaginal swab, and 67% preferred a vaginal swab over a pelvic examination 5.Cognitive learning theory in the classroom

A recent review in the new england journal of medicine in 2017 8 affirmed that ‘vaginal swabs are the preferred specimen type (for chlamydia trachomatis) because NAAT on vaginal swabs perform as well as those on cervical swabs, and collection is easy for most women to perform themselves.Cognitive learning theory in the classroom A first-catch urine specimen is also acceptable but may fail to detect up to 10% of cases.

In a new patient, I still carry out a full gynecological examination but perform lateral vaginal swabs in all women presenting with vulvovaginitis symptoms and/or for STI screening (based on health canada recommendations, it includes all sexually active women under the age of 25, any woman who had sex with an infected person, who have a new sexual partner or more than 1 sexual partner in the last year, or vulnerable populations such as intravenous drug users, incarcerated individuals, sex trade workers, street youth etc.) 9.Cognitive learning theory in the classroom

My medical office assistant is trained that if the patient calls for a “selfie”, as we call SAVS in the office, they need to be seen within 24-72 hours.Cognitive learning theory in the classroom patients are then asked to drop in at any time in the office to do the self-swabs. My MOA goes through the ‘how to do it’, and there are instructions in the bathroom wall as well (see attachment 3-4: self-administered vaginal swabs, “selfie”: yellow top and red top).Cognitive learning theory in the classroom

I always emphasize to my patients the difference between STI screening, recommended in all sexually active women under the age of 25, and the pap smear screening, for early detection of precancerous cells in the cervix, now only required after the age of 25 10. (see attachment 5: the pap smear ad testing for stds.) I always take every opportunity to educate my patients on stis prevention and failing that, the screening, diagnosis and the importance of early treatment.Cognitive learning theory in the classroom

Not only independent physicians are offering the self-swabs testing. The BC center for disease control 11 is now also offering self-swabbing (rectal and throat, but not vaginal), urine and blood tests for chlamydia, gonorrhea, HIV, syphilis and hepatitis C.Cognitive learning theory in the classroom patients can registered online, and then go to a lifelab to get the blood and/or urine work, and they are given a self-kit to take home. What tests are performed depend on a sexual history questionnaire that is completed online.Cognitive learning theory in the classroom if the results are abnormal, and advise is needed, a nurse calls the patient to discuss retesting or treatment. The family physician, if there is one, is not included in this drill.Cognitive learning theory in the classroom self-swabbing is available in vancouver, kamloops, nelson, victoria, langford and duncan.