Background Surveillance of Gonorrhoea resistance is a public health priority. At the Rotterdam STI clinic diagnostic tests for gonorrhoea are done by NAAT techniques from urine in men, and (self taken) vaginal swabs in women. For the purpose of resistance monitoring confirmation by culture is performed from urethra in men and cervix in women. In this study we evaluated whether culture is possible from vaginal swab, and whether women could perform this by self taken vaginal swabs.

Methods Gonorrhoea diagnostic is performed by SDA technique (BD-USA). For Culture swabs are put on GC-lect agar plates and incubated overnight at 30°C in CO₂ atmosphere. The next day transport to the laboratory is done in CO₂ jars. Cultures are examined for a maximum of 72 h. (Presumed) Positive cultures are identified by AccuProbe (BioMerieux-France). In phase 1 culture in female patients was performed by a health care provider by cervical swabs, in phase 2 by cervical and vaginal swab, in phase 3 a vaginal swab by the patient was added.

Results In Phase 1, 8/26 (31%) cervical cultures showed growth of gonorrhoea, 18 were negative. Mean time between PCR and culture was 18 days in positive and negative cases. In Phase 2, 21 women were cultured cervically and vaginally; 6/21 (29%) showed growth of gonorrhoea without discrepancies between the sites. In 17 women only vaginal swabs were taken, of whom 29% positive in culture. Mean time between PCR and culture was 20 days in positive and negative cases. In phase 3, seven women were cultured three times. 2/7 cultures (29%) were positive cervically and vaginally (professional and patient swab). The five other cases were all negative.

Conclusions Confirmation of vaginal gonorrhoea infection by culture was only achieved in 30% despite optimal laboratory methods. Gonococci can be grown from vaginal swabs, and no discrepancy was found between health care provider and patient taken swabs. Cultures taken for surveillance of resistance can be taken by women themselves without having to undergo physical examination.