Vaginal Secretions

One of the most common conditions diagnosed by health-care providers for female patients, particularly women of childbearing age

Vaginitis

Disease associated with abnormal vaginal discharge or odor, pruritus, vaginal irritation, dysuria, dyspareunia

Vaginitis

Most often, vaginitis is secondary to _

Bacterial vaginosis, Trichomoniasis, Vulovaginal candidiasis

Non-infectious conditions wherein Vaginitis may happen

Vaginal atrophy

Allergies

Chemical irritation

Gold standard to detect Vaginitis

Gram stain

Disease associated with Thin, homogenous, white-to-gray vaginal discharge

Bacterial vaginosis

Disease associated with White curd-like vaginal discharge

Candidiasis

Disease associated with Yellow-green frothy adherent vaginal discharge increased in volume

Trichomoniasis

Disease associated with Excessive purulent vaginal discharge, vaginal erythema

Desquamative inflammatory vaginitis

Atrophic vaginitis

Disease associated with pH of 3.8-4.5

Candidiasis

For ERO: Table for clinical features from left to right

Bacterial vaginosis, Candidiasis, Trichomoniasis, DIV, Atrophic vaginitis

pH of clinical features in vaginitis except for Candidiasis

>4.5

Disease associated with presence of Large clumps of epithelial cells

Candidiasis

Disease associated with 2+ to 4+ WBCs

Trichomoniasis

WBCs of diseases of Vaginitis except for Bacterial vaginosis and Trichomoniasis

3+ to 4+

Disease associated with >20% Clue cells

Bacterial vaginosis

Disease associated with Absent or Present clue cells

Trichomoniasis

Disease associated with Absent only Clue cells

Candidiasis

Diseases associated with Positive in Amine (Whiff) test

Bacterial vaginosis

Trichomoniasis

Diseases associated with presence of occasional parabasal or basal cells; >1+ RBCs

Desquamative Inflammatory Vaginitis

Atrophic vaginitis

Proline amino peptidase is a confirmatory test for _

Bacterial vaginosis

The health-care provider collects vaginal secretions during a _ examination

Pelvic examination

TRUE OR FALSE: A lot of lubricant must be used when collecting vaginal secretions

FALSE (Dapat none)

Type of swab used to collect vaginal smears

Polyester-tipped swab on a plastic shaft

Cotton swabs are toxic to _

Neisseria gonorrhoeae

Wood in the shaft may be toxic to _

Chlamydia trachomatis

Calcium alginate can inactivate _

Herpes simplex virus

Vaginal secretions, after collecting, are placed in a tube containing what and how many mL?

Sterile saline; 0.5 - 1.0mL

Swabs should be _ in the saline vigorously to dislodge particulates from the swab

Twirled

Specimens should be tested with _ before being placed in saline

pH paper

Alternative method of specimen preparation

Dilute sample of vaginal discharge in 1 or 2 drops of NSS on a microscope slide

Second sample is placed in a 10% KOH solution

Specimens should be placed in what bag, and must include what?

Biohazard bag with the requisition form

Content of requisition form

Patient name

Unique identifier

Medical history

Menstrual status

If there is suspicion of Trichomonas vaginalis and Neisseria gonorrhoeae, what temperature must the sample be?

Room temperature

If there is suspicion of C. trachomatis and Herpes simplex virus, what temperature must the sample be?

Refrigerated

Specimens for Trichomonas vaginalis must be examined within _ of collection

2 hrs

Strawberry cervix is associated with what disease?

Trichomoniasis

Unique symptom of Trichomoniasis

Strawberry cervix

Syndrome characterized by profuse purulent vaginal discharge, vaginal erythema, dyspareunia

Desquamative inflammatory vaginitis

DIV is caused by what group of bacteria

Beta hemolytic gram positive Streptococci

Diseases associated with postmenopausal women

Desquamative inflammatory vaginitis

Atrophic vaginitis

This syndrome is caused by thinning of the vaginal mucosa because of reduced estrogen production and decreased glycogen production

Atrophic vaginitis

Hormone that maintains the mucosa

Estrogen

Culture for flagellate Trichomonas developed in 1957; modified by CDC in 1980

Modified diamond culture technique

Normal appearance of vaginal secretions

White, flocculent discharge

In pH testing, what do we avoid that has a higher pH than the vagina?

Cervical mucus

Reagent use for Whiff test

10% Potassium hydroxide

When we prepare slides with NaCl on one and KOH on the other, what does the saline side visualize?

Trichomonas and Clue cells

When we prepare slides with NaCl on one and KOH on the other, what does the KOH side visualize?

Yeast

Amount of drops of NSS used to visualize Trichomonas and Clue cells

3-5 drops

Grade the quantitation scheme for microscopic examinations: <10 organisms or cells/slide

Rare

Grade the quantitation scheme for microscopic examinations: <1 organism or cell/hpf

1+

Grade the quantitation scheme for microscopic examinations: 1-5 organisms or cells/hpf

2+

Grade the quantitation scheme for microscopic examinations: 6-30 organisms or cells/hpf

3+

Grade the quantitation scheme for microscopic examinations: >30 organisms or cells/hpf

4+

Organism characterized by Large rods

Lactobacilli

A score of 7 or higher for Nugent’s gram stain criteria indicate what disease?

Bacterial vaginosis

In vaginal pH test strips, what’s the normal range?

4-4.5

When we smear the vaginal secretion on the pH strip, how long do we wait to read the results?

15 secs

This is a rapid test kit to aid the diagnosis of ruptured membranes

AmniSure

AmniSure has highly sensitive antibodies to detect the presence of _

PAMG-1

Is there normally high or low concentrations of PAMG-1 in vaginal discharge?

Low

Ruptured membranes will cause an increase or decrease in PAMG-1 in vaginal discharge?

Increased

AmniSure threshold for detection

5ng/mL

TRUE OR FALSE: AmniSure may be used in the presence of urine, vaginal infection, semen after intercourse, minimal amounts of blood, and in the presence of minimal amounts of water-based lubricant

TRUE

Temp at which we store AmniSure test kits

4-25C

When getting a vaginal sample for AmniSure, how many inches/cm do we insert the swab

2-3 in (5-7cm)

When we swab for AmniSure, how long do we swab for?

1 min

When we dilute the sample for AmniSure, how long do we rotate the swab?

1 min

When we take out the sample out of the foil pouch for AmniSure, we hold it at what colored end?

Blue end

We insert what colored end of the test strip with two arrows facing downwards into the vial

White end

For AmniSure, how long do we wait or until when we can read the results?

Wait 5 mins; or until two lines appear

We cannot read AmniSure’s results after _

10 mins

Is AmniSure quanti or qualitative?

Qualitative

In rare cases, when the sample is taken greater than _ after a rupture, it may result to a FALSE NEGATIVE IN AMNISURE

12-24 hrs

TRUE OR FALSE: Women can labor spontaneously despite a negative test result in AmniSure

TRUE

This is a glue-like protein that helps bond the baby’s membrane to the mother

Fetal fibronectin

FFN test kit temperature to store

Room temp (15-30C)

For FFN test, how long do we swirl

10 secs