Table 1 Recommendations for sample collection for the diagnosis of genital herpes infections, adapted from Domeika and colleagues[9]

Male skin or mucous membrane lesions

• Sterile needles

• Unroof the vesicles with a sterile needle

• Sterile cotton-tipped, Dacron or nylon flocked swab on a wooden, plastic or aluminium shaft

• Collect the content of the vesicles with a sterile swab and:

○ apply to a microscope slide (for immunofluorescence staining) or ○ introduce into transport media for viral culture or NAAT.

• Microscope slides

Male urethra

• Sterile cotton-wool, Dacron or nylon flocked swab on a wooden, plastic or aluminium shaft

• Clean the external urethral opening region with a swab moistened in saline

• Draw back the prepuce to avoid contamination when sampling

• Insert a sterile swab carefully into the external urethral meatus (to a depth of 0.5–2 cm) and collect urethral exudates for testing

Female skin or mucous membrane lesions

• Gauze and cotton swabs,, dacron or nylon flocked swab on a wooden, plastic or aluminium shaft

• Similarly as for male skin or mucous membrane lesions

• Microscope slides

Female urethra

• Sterile gauze swab (to remove excess discharge)

• Clean the introitus using a sterile gauze swab

• Sterile cotton-wool, Dacron or nylon flocked swab on an aluminium shaft

• Carefully insert a sterile swab on an aluminium shaft into the urethra (to a depth of 0.5 cm) to collect exudates for testing

Cervix

• Vaginal speculum

• Insert the vaginal speculum, which may be moistened in advance with warm water and

• Sterile gauze swab

• Sterile cotton-wool, Dacron or nylon flocked swab on a wooden or plastic shaft

• clean the cervical canal opening thoroughly with a sterile gauze swab

• Insert a cotton-wool or Dacron swab carefully into the cervical canal (to a depth of 2 cm) and collect the material from lesions.

Vagina

(of prepubertal girls)

• Sterile cotton-wool, Dacron or nylon flocked swab on an aluminium shaft

• Insert a sterile swab on an aluminium shaft carefully through the hymen into the vagina, and collect the material from the back wall of the vagina

Urine

• Sterile container for urine

• Ask the patient to collect the first 10–20 ml of voided urine (first catch)

• The patients should avoid urinating for least two hours before sampling

Conjunctiva

• Sterile cotton-wool, Dacron or nylon flocked swab on an aluminium shaft

• purulent discharge must be removed before sampling with a sterile swab

• Kimura platinum conjunctival scraper

• Move a swab over the conjunctiva of the inferior eyelid towards the interior angle of the eye (use a thin swab on an aluminium shaft for newborns)

• Topical ophthalmic local anaesthetic

• The Kimura scraper is used to sample the bases of lesions (either ulcers or the bases of burst vesicles). Before collecting the sample, the spatula is sterilised by heating in a flame and allowed to cool

Rectum ^a

• Rectal speculum or proctoscope

• Rectal material is taken under direct vision, with the aid of a proctoscope or rectal speculum. Use of a blind technique results in considerable loss of sensitivity

• Sterile cotton-wool, Dacron or nylon flocked swab on a wooden or aluminium shaft

• Insert a swab on a wooden or plastic shaft to a depth of 3 cm and collect the material from all rectal walls by circular motions for 10 seconds

• If faecal material is impacted, the swab should be discarded and the sampling procedure repeated.