Microbiology - Neisseria Gonorrhoeae
Clinical specimens such as cervical, rectal or throat swabs are not accepted by the SLPH for primary isolation of Neisseria gonorrhoeae (GC). Primary culture is available through the local health department Sexually Transmitted Disease (HIV/STD) Program. Reference cultures are accepted from public and private health care providers for confirmation. Cultures may be forwarded to the CDC for antimicrobial susceptibility studies in special circumstances.
Suspected cultures of GC should be confirmed in the following instances:
- cultures from anatomic sources other than urogenital sites in symptomatic patients
- rectal cultures in homosexual males
- cases involving children
- any other legal case
- if there is any question regarding the local laboratory´s interpretation of biochemical or microscopic test results
To submit reference cultures transfer a well-isolated colony from the primary isolation plate to a fresh JEMBEC plate (see also SHIPMENT OF SPECIMENS, below). Martin-Lewis, Thayer-Martin, GC-Lect® and Chocolate agar slants or plates are also satisfactory. Isolates of neisseriae other than gonococci may be submitted on blood, chocolate or infusion agar.
Clearly label each specimen with the patient´s name and submit with Special Bacteriology DHHS Form 4121. Unlabeled specimens will not be tested. Please indicate if a specimen is a legal case.
Lab records are computerized and the following data are required: patient name, patient Social Security Number (or assigned number), date of birth, patient Medicaid number (if applicable), submitter Federal Tax Number (Employer Identification Number), submitter return address, specimen collection date and specimen source. Without these data, specimen records cannot be entered into the computer, nor can a report of results be printed. Other data are helpful for epidemiological follow-up and for statistical purposes.
Specimens received without submitter return address are subject to rejection!
Cultures should be incubated overnight or until growth is visible before shipment. Slant cultures should be overlaid with sterile broth (such as infusion broth) to within one inch of the top of the tube, sealed with tape and placed in a leakproof container before shipping. The submitting laboratory should maintain an additional culture in the event the isolate does not survive shipment.
JEMBEC plates or commercially available media for gonococci are suitable for submitting cultures to the SLPH for confirmation. Health department STD clinics may obtain mailers for JEMBEC plates from the SLPH, Laboratory Improvement Branch by telephoning (919) 733-7186. Cultures must be maintained in an atmosphere of 3-10% CO2 during shipment. Plate cultures in a CO2 environmental transport system should be cushioned against breakage. Use Microbiology Reference Culture mailer for isolates submitted on tubed media; use double-walled or equivalent containers that meet safety requirements.
Place completed identification DHHS form 4121 in the outer container, or in a sealed plastic bag to prevent wetting and contamination in case of leakage. Multiple specimens should be wrapped individually in absorbent cushioning material and securely packaged in a leak-proof container.
Plainly label "Neisseria gonorrhoeae," or "GC culture" and "DO NOT REFRIGERATE" on the outside of the package, and address to "Atypical Bacteriology". Every effort should be made to protect cultures from temperature extremes during shipment; cultures should never be refrigerated. Shipment should be timed so that cultures do not arrive on Fridays or weekends. Special arrangements may be made for handling urgent cases by telephoning the Microbiology Branch at (919) 733-7367.
Ship specimens as soon as possible after collection. Please note: Neisseria sp. die easily and should be freshly subbed to a chocolate slant or transport systems such as the Jembec plate. Incubation for 18 to 24 hours prior to transport enhances survival. Do not ship on a friday or holiday weekend. Write "DO NOT REFRIGERATE" on the outside of the package.
When shipping by U.S. Mail, use first-class postage. Be sure to place return address on outside of container, regardless of shipping method. Telephone the Microbiology Branch prior to shipping large numbers of specimens or those requiring urgent attention.
Reporting Procedure and Interpretation
Gonococcal cultures are reported as "Neisseria gonorrhoeae. " Non-gonococcal neisseriae are identified to the genus or species level as appropriate. Results usually are reported within one to three work days unless difficulty is encountered in growing the organism or isolating it from a mixed culture. Results can be accessed via the secure web page for results to https://slphreporting.ncpublichealth.com/lims.
Reports are returned only to the submitting agency; the submitter is responsible for sending copies to any other agency. The submitting agency is responsible for maintaining reports in the patient´s file.
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