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A randomised controlled trial to assess pain with urethral swabs
  1. Ade Apoola,
  2. Maite Herrero-Diaz,
  3. Elley FitzHugh,
  4. Raj Rajakumar,
  5. Apostolos Fakis,
  6. Jayne Oakden
  1. Department of Genito-urinary Medicine, Derby Foundation Hospital NHS Trust, Derby, UK
  1. Correspondence to Dr Ade Apoola, Department of Genito-urinary Medicine, Derby Foundation Hospital NHS Trust, London Road, Derby DE1 2QY, UK; apoola{at}


Background Urethral swabs are uncomfortable due to the nature of the mucosa and may be a reason for non-attendance of men at sexually transmitted infection (STI) clinics. This randomised controlled trial describes the extent of discomfort associated with direct urethral sampling, and determines whether this varies by the type of swab used.

Methods Male patients over the age of 16 years having swab tests were invited to participate and were randomly assigned to receive either a gonorrhoea dacron-tipped swab, a chlamydia rayon-tipped swab or a plastic 10 μl urethral loop first for urethral sampling followed by the others sequentially. Discomfort was measured using a 0–100 mm visual analogue scale (VAS).

Findings 129 men having urethral swabs carried out as part of their screening tests for STI were invited to participate in the study and 121 were recruited. The median pain scores (IQR) regardless of sampling method, before and after the urethral sampling were, first 0 mm (0–0) and 50 mm (22–71) (p<0.001), second 9 mm (0–28) and 59.5 mm (38.3–78) (p<0.001) and third 10 mm (0–31) and 58 mm (29.3–80) (p<0.001). Direct urethral sampling was associated with a median pain score of 60.5 mm using a rayon swab, 52 mm using a dacron swab and 25.5 mm using a plastic loop.

Interpretation Direct urethral sampling is associated with discomfort and/or pain in men, which was significantly greater with a swab than a plastic loop. Urine should therefore be the specimen type of choice. When direct urethral sampling is indicated a loop is preferable to a urethral swab.

International Standard Randomised Controlled Trial Number Register number ISRCTN50938901.

  • Chlamydia trachomatis
  • genital specimens
  • men
  • Neisseria gonorrhoeae
  • pain
  • randomised controlled crossover trial
  • sexually transmitted infections
  • trials
  • urethral swab

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  • Funding The authors were funded as part of their clinical work.

  • Competing interests None to declare.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Derbyshire research ethics committee, ref: 07/H0401/158.

  • Provenance and peer review Not commissioned; externally peer reviewed.