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Antigen and molecular testing using one swab: Lessons learned from a COVID-19 project
Jodi Gilchrist1, Nicole Smieja2, Sarah Marttala2
1Research St. Joseph's -Hamilton, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Diagnostic Microbiology and Infectious Disease
|November 16, 2025
Summary
Rapid antigen and RT-PCR testing on a single nasopharyngeal swab improves SARS-CoV-2 detection, including asymptomatic cases. This efficient strategy enhances diagnostic yield while minimizing patient and resource burdens.
Area of Science:
- Virology
- Diagnostic Medicine
- Public Health
Background:
- Rapid detection of SARS-CoV-2 is crucial for controlling viral transmission.
- Current diagnostic methods may involve separate sample collection for different tests, increasing patient discomfort and resource use.
Purpose of the Study:
- To evaluate the performance of a one-swab-two-test strategy combining antigen and RT-PCR testing for SARS-CoV-2.
- To assess the diagnostic yield and efficiency of using a single nasopharyngeal swab for both tests.
Main Methods:
- Nasopharyngeal swabs were collected for both Panbio antigen testing and subsequent RT-PCR analysis.
- Performance was evaluated by comparing results from the combined strategy with standard PCR methods.
- Concordance rates and case detection, including asymptomatic infections, were analyzed.
Main Results:
- High concordance was observed between the RT-PCR results from the single swab and standard PCR.
- The one-swab-two-test strategy demonstrated improved overall case detection compared to antigen testing alone.
- Detection of asymptomatic SARS-CoV-2 infections was enhanced by this approach.
Conclusions:
- The one-swab-two-test strategy using a single nasopharyngeal swab is a highly effective method for SARS-CoV-2 detection.
- This approach enhances diagnostic yield, improves detection of asymptomatic cases, and reduces patient discomfort and healthcare resource burden.
