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Microbiology culture remains the diagnostic standard for gonococcal infection. Isolation of the pathogen confirms the clinical diagnosis and allows assessment of the antimicrobial susceptibility of the gonococcal strain, guiding effective therapy. The sensitivity of endocervical swab culture has been reported as 80–90% but this varies with the quality of culture media and adequacy of the specimen.1 The gonococcus is a nutritionally demanding bacterium, readily inhibited by adverse culture conditions.
For decades, doctors in genitourinary medicine have been advised to lubricate metal vaginal specula with water only. With the increasing use of disposable vaginal specula, which are more difficult to insert, some workers have promoted the use of vaginal lubricants, such as KY jelly, to reduce patient discomfort during clinical examination and specimen collection.
Figure 1 shows five randomly selected clinical strains of Neisseria gonorrhoeae inoculated by swab (104/ml) and growing readily on gonococcal sensitivity agar except in the central region of the plate where a line of KY jelly has inhibited growth.
Some studies have demonstrated the inhibitory actions of various vaginal lubricants, including KY jelly, against N gonorrhoeae,2 while others have found KY jelly to be relatively non-toxic to both chlamydia and gonococci.3
In view of these conflicting findings, prospective studies are required to assess the clinical significance of using vaginal lubricants when collecting specimens for gonococcal culture. Pending the completion of such studies we recommend that vaginal lubricants should not be used when obtaining endocervical samples for microbiological investigation.
REH, design of practical work, literature review, production of first draft of manuscript; JDJ, performance of practical work, literature review, critical comment on draft manuscript; FD identification of clinical issue, literature review, critical comment on draft manuscript.