1. Laboratory Procedure Courses National Network of Prevention Training Centers
Linda Creegan, MS, FNP
California STD/HIV Prevention Training Center
Oakland, CA
National STD Prevention Conference
Chicago, March 2008

2. CLINICIANS….. Are you new to the STD clinic?
Is your clinic starting to use a new test?
Herpes?
Trichomoniasis?
Bacterial
Vaginosis?
Syphilis?
Rapid HIV test?
Darkfield microscopy?

3. Enroll in an NNPTC laboratory procedure course!!
Tests for STD specialty clinics
Syphilis tests
Gram stains
Saline and KOH wet mounts
Point-of-Care (POC) tests for STD

4. Tests for STD Specialty Clinics

5. Syphilis Tests Serologic tests for syphilis Darkfield microscopy
Learn to perform and interpret the qualitative RPR test
Darkfield microscopy
Learn to
Obtain the specimen
Use the microscope
Identify T. pallidum by morphology and motility

6. Utility of Rapid RPR Test
Evaluation of patients with symptoms of primary and secondary syphilis
Facilitates immediate diagnosis, treatment, and initiation of partner management activities

7. Darkfield Microscopy Photo credit: Dr. Joseph Engelman,
San Francisco City Clinic

8. Identifying T. pallidum by DF
Morphology
Rigid, uniform, tightly-wound spirals
Tight coil is maintained despite active motility
Length: 6-20 micrometers
Width: VERY thin
micrometers, below the resolution of the light microscope
Motility
Exhibits three types of movement
Translation: slow, forward or backwards movement
Rotation: turning around the longitudinal axis
Flexion: stiff bending, usually in the middle, and returning to original position

9. Gram Stains Male urethral discharge, cervical and rectal specimens
Learn to
Obtain the specimen
Identify WBCs and GNID
Diagnose gonococcal vs non-gonococcal urethritis
STD Atlas, 1997

10. Saline and KOH Wet Mounts Vaginal specimens
Learn to
Obtain the specimen
Use the microscope
Identify findings (Clue cells, yeast forms, trichomonads)
Diagnose BV, yeast, trich
Photo credit: Seattle STD/HIV
Prevention Training Center

11. Point-of-Care Tests for STD

12. What are Point-of-Care tests?
Rapid diagnostic tests
Run in clinic or field setting
Very easy to perform
Usually require only microscope or simple lab equipment
Often CLIA waived
Provide results at same clinic visit
Diagnostic and screening applications
Probably most of the tests we order are sent to a lab, and the results come back to us on a delayed basis. However, point-of-care tests are available for some STDs. These are tests that are run on-site by the clinician or other staff, and provide results in a short period of time.

13. Point-of-Care STD Tests: A Paradox
Generally not as sensitive as delayed lab tests
In populations where patients are less likely to return for results or F/U is difficult, higher treatment levels can be achieved with POC than with delayed tests
Homeless clinics
Emergency rooms
Correctional facilities
However, these point-of care tests are generally less sensitive and/or specific than are the lab-based tests. So why would any clinician want to use a less sensitive test? Well, if your population is not likely to return in a week for results, or if follow-up on the clinic’s end is going to be time-intensive and difficult, higher levels of treatment can actually be achieved using POCs, and getting the result while the patient is there with you, than risking the loss to follow-up. So these tests could be especially useful with homeless patients, in ERs, or in jails, where patients are often released before a test result comes back from the lab.

14. Point-of-Care Test Courses
Learn about
Lab regulatory issues (CLIA)
POC tests for genital herpes, vaginitis, syphilis, CT and GC, and HIV
Obtaining specimens
Using test kits
Interpreting results
Maintaining quality assurance