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).

Indications for Swabbing a Throat

In patients with tonsillopharyngitis, a throat swab may need to be tested primarily to diagnose:

• Group A beta-hemolytic streptococci (GABHS) infection
• Gonococcal infection

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:

• Tonsillar exudate
• Tender lymphadenopathy
• Fever (on examination or by history)
• Absence of cough

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

None

Complications of Swabbing a Throat

• None

The swab may cause brief, minor gagging.

Equipment for Swabbing a Throat

• Sterile swab
• Tongue depressor
• Light source; flexible lamp or head-mounted light

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

The tonsils are located along the sides of the posterior oropharynx. They lie between the anterior and posterior pillars of the throat.

Positioning for Swabbing a Throat

Sitting position with head tilted back slightly

Step-by-Step Description of Swabbing a Throat

• Explain the procedure to the patient, including that they may gag briefly.
• Wear gloves and eye protection, and if COVID-19 (or any other airborne infection) is under consideration, gown, N95 respirator, and face shield.
• Position the patient and light source to illuminate the posterior oropharynx.
• Have the patient open the mouth and relax the tongue by saying “aaaah.”
• Press the tongue down using a tongue depressor.
• Gently rub the swab against both tonsils and the posterior pharynx.
• Place the swab in the culture medium, transport medium, or sterile test tube.

Aftercare for Swabbing a Throat

Follow-up on test results.

Warnings and Common Errors for Swabbing a Throat

• Touching the swab to the tongue or sides of the mouth
• Not swabbing all 3 sites in the pharynx

Tips and Tricks for Swabbing a Throat

• Proceed swiftly because the patient will likely gag.
• Having the patient stick out the tongue actually stiffens it and can make it harder to see the pharynx.

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).

Indications for Swabbing a Throat

In patients with tonsillopharyngitis, a throat swab may need to be tested primarily to diagnose:

• Group A beta-hemolytic streptococci (GABHS) infection
• Gonococcal infection

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:

• Tonsillar exudate
• Tender lymphadenopathy
• Fever (on examination or by history)
• Absence of cough

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 Throa

None

Complications of Swabbing a Throat

• None

The swab may cause brief, minor gagging.

Equipment for Swabbing a Throat

• Sterile swab
• Tongue depressor
• Light source; flexible lamp or head-mounted light

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

The tonsils are located along the sides of the posterior oropharynx. They lie between the anterior and posterior pillars of the throat.

Positioning for Swabbing a Throat

Sitting position with head tilted back slightly

Step-by-Step Description of Swabbing a Throat

• Explain the procedure to the patient, including that they may gag briefly.
• Wear gloves and eye protection, and if COVID-19 (or any other airborne infection) is under consideration, gown, N95 respirator, and face shield.
• Position the patient and light source to illuminate the posterior oropharynx.
• Have the patient open the mouth and relax the tongue by saying “aaaah.”
• Press the tongue down using a tongue depressor.
• Gently rub the swab against both tonsils and the posterior pharynx.
• Place the swab in the culture medium, transport medium, or sterile test tube.

Aftercare for Swabbing a Throat

Follow-up on test results.

Warnings and Common Errors for Swabbing a Throat

• Touching the swab to the tongue or sides of the mouth
• Not swabbing all 3 sites in the pharynx

Tips and Tricks for Swabbing a Throat

• Proceed swiftly because the patient will likely gag.
• Having the patient stick out the tongue actually stiffens it and can make it harder to see the pharynx.