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If you are preparing a patient for a throat swab you should ask him if he used mouthwash or antibiotics because either one could influence an inaccurate culture from removing bacteria.  If the patient is confused why it is not a good idea to remove bacteria from the infected area explain to him that removal from the immediate area does not mean that the infection is cured. Indeed, he may still be a carrier and failure to detect the infection will prolong the period of infection, possibly infecting others. Inform the patient that this is a relatively painless procedure and does not require any special instructions once the tests are concluded. Other questions you can ask your patient are: “What symptoms have you noticed, and how severe are they?”, "For how many days?",  "When did it start?", "How has it progressed?", “Have you experienced a fever the last couple of days?”, and “Have you been in contact with anybody who has had strep throat recently?” In order to check for redness, swelling, and especially for white streaks or pus on the tonsils, you must use a tongue depressor to get a good look at the tonsils and throat.  You should also try to detect signs of a strep throat: fever, white or yellow spots that coat the lining of the throat, bright and dark red spots near the throat, and swollen tonsils. A visual exam of the throat and tonsils cannot determine whether the signs and symptoms are bacterial or viral; therefore, further testing will be needed. Once signs and symptoms have been detected, you will have to perform a throat swab to check for the presence of bacteria, including streptococcal bacteria. A throat swab is done to collect any bacteria that exist for a throat culture to determine if the infection is caused by a virus or by bacteria. The result will determine the treatment.  Using a sterile cotton swab, touch the infected area with the swab with several strokes to collect any pathogenic or bacteria for a microbiologist to analyze. Be careful not to touch the tongue, uvula, or lips due to possible contamination. This should not be a painful procedure but expect your patient to gag since you will touch the back of her throat. Prepare the swab for transportation to the laboratory for analysis. Always label the sample with patient name, date of birth, and patient ID. This test is usually only performed in an emergency or with children because it can provide immediate feedback on the swab sample.  This test detects strep bacteria within a few minutes by revealing substances (antigens) from the throat. Once located, antibiotic treatment can begin immediately. The downside to this test is that due to its rapid analysis some strep throat infections are misdiagnosed; therefore, it is a good idea to proceed with a culture, especially if the antigen test shows a negative result. Inoculate the culture with the sterile swab and carefully place it into a collection container. If you need a quick strep test or a strep screen, use a red Duo-Swab in transport media. Otherwise, place the culture in a blue Amies transport media for a throat culture.  Make sure you label the transport media correctly or there could be confusion over the proper procedures for treatment, leading to serious complications. The collection container should arrive at the laboratory within 24 hours for proper analysis. The culture should be placed in a candle jar and incubated at 35–37° C (95–98° F). You should leave the jar in the incubator for at least 18 hours.  After 18–20 hours, take out the jar and examine the bacteria (content beta hemolytic) colonies. If you find any trace of a colony, the test is positive, and the patient suffers from a bacterial infection. It will need further examination to determine just what bacteria are present. If nothing will grow in the container, the test is negative. If the test results are negative, the patient might suffer from a viral infection, caused by pathogens like Enterovirus, the Herpes simplex virus, Epstein-Barr virus, or RSV (respiratory syncytial virus). Chemical tests or microscope exams will need to be performed in order to find what type of infection is affecting the patient. Remember, viral infections are not treatable with antibiotics. Viral infections require time and rest for the body to fight infection using its own immune response.
Ask if your patient used mouthwash or antibiotics. Use a tongue depressor. Perform a throat swab. Administer a rapid antigen test. Prepare swab for the laboratory. Analyze the culture.