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.)
Indications for Swabbing a Throat
In patients with tonsillopharyngitis, a throat swab may need to be tested primarily to diagnose:
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:
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 is suspected.
Contraindications to Swabbing a Throat
Complications of Swabbing a Throat
Equipment for Swabbing a Throat
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 for Swabbing a Throat
Positioning for Swabbing a Throat
Step-by-Step Description of Procedure
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Explain the procedure to the patient, including that they may gag briefly.
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Wear gloves and eye protection, and if COVID-19 is under consideration, gown, N95 respirator, and face shield.
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Position the patient and light source to illuminate the posterior oropharynx.
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Have the patient open the mouth and relax the tongue by saying "aaaah."
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Press the tongue down using a tongue depressor.
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Gently rub the swab against both tonsils and the posterior pharynx.
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Place the swab in the culture medium, transport medium, or sterile test tube.
