Testing may involve traditional culture on sheep blood agar (GABHS) or Thayer-Martin medium (gonorrhea), rapid antigen testing (GABHS), or nucleic acid amplification testing (gonorrhea, COVID-19).
(See also Streptococcal Infections Streptococcal Infections Streptococci are gram-positive aerobic organisms that cause many disorders, including pharyngitis, pneumonia, wound and skin infections, sepsis, and endocarditis. Symptoms vary with the organ... read more 
.)
Indications
In patients with tonsillopharyngitis Tonsillopharyngitis Tonsillopharyngitis is acute infection of the pharynx, palatine tonsils, or both. Symptoms may include sore throat, odynophagia, cervical lymphadenopathy, and fever. Diagnosis is clinical, supplemented... read more 
, a throat swab may need to be tested primarily to diagnose:
Group A beta-hemolytic streptococci (GABHS) infection
Gonococcal infection
Gonococcal pharyngitis may be suspected in patients with known or possible exposure to gonorrhea (eg, recent oral-genital contact).
Criteria suggestive of need for testing for GABHS pharyngitis include the presence of ≥ 2 of the following:
Tonsillar exudate
Tender lymphadenopathy
Fever (on examination or by history)
Absence of cough
Threshold for GABHS testing may be lower in patients at increased risk because of diabetes or immunocompromise.
Throat swabs are also sometimes tested if COVID-19 COVID-19 COVID-19 is an acute, sometimes severe, respiratory illness caused by the novel coronavirus SARS-CoV-2. Prevention is by vaccination, infection control precautions (eg, face masks, handwashing... read more is suspected.
Contraindications
None
Complications
None
The swab may cause brief, minor gagging.
Equipment
Sterile swab
Tongue depressor
Light source; flexible lamp or head-mounted light
Use swabs supplied with the specific test kit being used or by the facility's laboratory. If none are supplied, use a swab with a plastic or wire shaft and a rayon, Dacron, or calcium alginate tip. Avoid swabs with wooden shafts and/or cotton tips because these materials may interfere with certain tests.
Relevant Anatomy
The tonsils are located along the sides of the posterior oropharynx. They lie between the anterior and posterior pillars of the throat.
Positioning
Sitting position with head tilted back slightly
Step-by-Step Description of Procedure
Explain the procedure to the patient, including that they may gag briefly.
Wear gloves and eye protection, and if COVID-19 is under consideration, gown, N95 respirator, and face shield.
Position the patient and light source to illuminate the posterior oropharynx.
Have the patient open the mouth and relax the tongue by saying "aaaah."
Press the tongue down using a tongue depressor.
Gently rub the swab against both tonsils and the posterior pharynx.
Place the swab in the culture medium, transport medium, or sterile test tube.
Aftercare
Follow-up on test results.
Warnings and Common Errors
Touching the swab to the tongue or sides of the mouth
Not swabbing all 3 sites in the pharynx
Tips and Tricks
Proceed swiftly because the patient will likely gag.
Having the patient stick out the tongue actually stiffens it and can make it harder to see the pharynx.
