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Transurethral Induction of Mouse Urinary Tract Infection
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Meatal Swabs Contain Less Cellular Material and Are Associated with a Decrease in Gram Stain Smear Quality Compared

Stephen J Jordan1, Jane R Schwebke2, Kristal J Aaron2

  • 1Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA sjjordan@uabmc.edu.

Journal of Clinical Microbiology
|May 12, 2017
PubMed
Summary

Meatal swabs are inadequate for Gram stain testing of urethritis in men when no discharge is present, leading to higher failure rates compared to urethral swabs. Avoid meatal swabs for point-of-care diagnosis without visible discharge.

Keywords:
Chlamydia trachomatisGram stainNeisseria gonorrhoeaemeatal swabsurethral swabs

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Area of Science:

  • Microbiology
  • Clinical Diagnostics
  • Urology

Background:

  • Urethral swabs are standard for diagnosing Neisseria gonorrhoeae and nongonococcal urethritis (NGU) via Gram stain.
  • Meatal swabs offer a less invasive alternative for N. gonorrhoeae and Chlamydia trachomatis testing (NAAT), but their adequacy for Gram stain is uncertain.

Purpose of the Study:

  • To compare the cellular adequacy of meatal swabs versus urethral swabs for Gram stain smears.
  • To determine the Gram stain smear (GSS) failure rate due to insufficient cellular material for both swab types.

Main Methods:

  • 66 men underwent either urethral or meatal swabbing.
  • Cellular content was measured using the Cepheid Xpert CT/NG sample adequacy control crossing threshold (SACCT).
  • Gram stain smear (GSS) failure rates were calculated based on insufficient cellularity.

Main Results:

  • In the absence of discharge, meatal swabs showed significantly reduced cellular content (P = 0.0118).
  • Meatal swabs had a significantly higher GSS failure rate (45%) compared to urethral swabs (3%) when no discharge was present (P < 0.0001).
  • No significant difference in cellular content or GSS failure rate was observed when discharge was present.

Conclusions:

  • Meatal swabs are not suitable for point-of-care Gram stain testing for N. gonorrhoeae or NGU in men if visible discharge is absent.
  • Urethral swabs remain the preferred sample type for Gram stain testing in the absence of discharge.
  • Meatal swabs may be adequate for NAAT but should be avoided for Gram stain testing without visible discharge.