P155 Evaluating the effectiveness of gram stain microscopy in identifying gram negative intracellular diplococci suggestive of gonorrhoea neisseria

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Abstract

Introduction

Gram stain microscopy is an effective tool in the management of gonorrhoea in symptomatic patients, allowing for the visual identification of suspicious bacteria, which when also considering the history and risk, can be indicative of a current gonorrhoea infection allowing for rapid treatment and partner notification initiation. This is an on-going audit to verify the effectiveness of in-house diagnostics.

Methods

All patients found to have a positive culture result for gonorrhoea had their notes reviewed to ascertain if presumptive gonorrhoea had been diagnosed at attendance as well as the presence of symptoms, contact status and vaginal flora grade (in women). If microscopy was undertaken but negative, the slide was also reviewed. Slides found to be positive were feedback to staff members.

Results

Data from July 2016 – January 2017:

Male urethral samples

147/157 (93.6%) infections were correctly identified, when asymptomatic contacts were excluded 147/154 (95.5%) were identified, and of those not identified, 4 were negative on review.

Female cervical samples

5/20 (25%) infections were correctly identified, when asymptomatic contacts were excluded 5/19 (26.3%) were identified. Of those not diagnosed on the day, 9 were negative on review.

Discussion

Microscopy identified 95.5% of symptomatic male urethral infections and 26.3% of female cervical samples. There was also a low ‘failure’ rate, only 7/24 slides were positive on review and therefore ‘true missed’ on day diagnoses. Effective on day diagnosis can prevent further transmission, allow faster access to antibiotics, allow for prompt partner notification and is a rewarding skill for the GU staff.

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