Vaginal Secretion Analysis

What are some purposes of analyzing vaginal secretions?

- Diagnose infection

- Detect pregnancy complications

- Workup of sexual assault

For vaginal secretion collection, a speculum must be used without ______.

lubricant

What areas should be swabbed for vaginal secretion collection?

- Vaginal walls

- Vaginal pool

No wooden shaft, no cotton, no calcium alginate swabs

Normal vaginal secretion appearance

White, flocculent

Normal vaginal secretion pH

3.8-4.2

Normal vaginal secretion Amine (Whiff) test result

Negative

Normal vaginal secretion WBC level

2+

Normal vaginal secretion clue cell levels

Clue cells

Normal vaginal secretion other cells

None other than RBCs during menses

Normal vaginal secretions may have ______ in small amounts.

yeast

What are some common organisms causing ulcerative lesions as part of a vaginal tract infection?

- Treponema pallidum

- Haemophilus ducreyi

- Herpes Simplex Virus

Treponema pallidum is detected via blood testing for ______ and ______.

anti-T. pallidum Abs, RPR

Haemophilus ducreyi can be detected via ______ of lesion material.

gram stain

Herpes Simplex Virus can be detected via ______ on lesion material or blood for antibodies.

NAA

What organisms commonly cause exudative vaginal tract infections?

- Neisseria gonorrhoeae

- Chlamydia trachomatis

- Yeast (Candida)

- Trichomonas vaginalis

- Bacterial vaginosis

Neisseria gonorrhoeae can be detected via ______ on discharge.

NAA

Chlamydia trachomatis can be detected via ______ on cervical scrapings.

NAA

Candida can be detected via ______ prep on discharge.

KOH

Trichomonas vaginalis can be detected via ______ for motile organisms.

wet prep

Bacterial vaginosis is diagnosed via ______ test and ______ for altered flora.

Whiff, gram stain

______ is the most common cause of vaginal discharge, prevalent in 40-50% of women.

Bacterial Vaginosis

What are some complications that can arise with a BV infection?

Mainly fetal complications

- Amniotic fluid infection

- Post cesarean endometritis

- Histological chorioamnionitis

- Premature rupture of membranes

- Premature labor and delivery

- Fetal loss

- Low birth weight

- PID

- HIV acquisition and transmission

What are some BV risk factors?

- Douching

- Increased number of partners

- Lower socioeconomic groups

- Women who have sex with women

What organisms are associated with BV?

- Gardnerella vaginalis

- Mobiluncus

- Porphyromonas

- Prevotella

- Peptostreptococcus

- Mycoplasma hominis

- Atopobium vaginae

Normally, ______ predominate in the vaginal flora. What is the gram stain of this bacteria?

lactobacillus; large, regular, GPR

With BV, there are no ______ present.

lactobacilli

With BV, the anaerobe to aerobe ratio changes from 2:1 to 5:1 to _______.

100:1 to 1000:1

What bacteria are seen with BV?

Small GPR and GNR, curved rods

To diagnose BV, 3 out of 4 criteria must be met. What are the criteria?

- Watery discharge with no PMNs

- pH over 4.5

- Over 20% clue cells

- Fishy odor

Clue cell

Epithelial cell covered with bacteria

What are some difficulties that can arise with clinical diagnosis of BV?

- Normal discharge vs. discharge of BV

- False elevation of pH

- Microscope access

- Amino odor is the most specific but least sensitive

- 40-60% of healthy women have Gardnerella as normal flora

To diagnose BV, a ______ can be done on vaginal secretions.

culture

Doing a ______ can also be used to diagnose BV, which is less expensive, quicker, and more accessible.

gram stain

What are the gram stain morphotypes?

- Medium to large, regular shaped GPR

- Small GPR

- Small GNR

- Curved GVR

Gram staining uses the ______ Scoring System.

Nugent

What are the ranges of the Nugent Scoring System?

0/OIF = 0

<1/OIF = 1+

1-5/OIF = 2+

5-30/OIF = 3+

>30/OIF = 4+

Many lactobacilli (4+) receives a Nugent Score of ______, while none (0) receives a ______.

0, 4

Medium to large regular shaped GPR

Gardnerella Nugent Scores

Many (4+) = 4

No (0) = 0

Small GPR or GNR

Mobiluncus Nugent Scores

Moderate to many (3+ to 4+) = 2

No (0) = 0

Small/large curved GVR

Once all the morphologies are scored, they are ______.

added

Nugent Score of 0-3 is ______ for BV.

negative

Nugent Score of 4-6 means the patient has ______.

altered vaginal flora

Nugent Score of 7-10 is ______ for BV.

positive

WBCs are rare or absent in ______.

BV

Candidiasis fluid appearance

White, curd-like

Candidiasis pH

Normal (3.8-4.2)

Candidiasis clue cells

None

Candidiasis Whiff test

negative

Candidiasis WBCs

3+ to 4+

Trichomoniasis fluid appearance

Yellow-green, frothy

Trichomoniasis pH

Over 4.5

Trichomoniasis clue cells

Absent or present

Trichomoniasis Whiff test

Positive

Trichomoniasis WBCs

2+-4+

Premature rupture of fetal membranes causes leakage of ______ into vaginal secretions.

amniotic fluid

A positive fetal fibronectin indicates a risk of ______.

premature delivery

A negative fetal fibronectin indicates ______ chance of preterm delivery within the next 7-10 days.

little to no

A positive ______ value is indicative of fetal membrane rupture and the presence of amniotic fluid in vaginal secretions.

PAMG-1 (placental alpha-macroglobulin-1)

The ______ test can also be used to detect amniotic fluid in vaginal secretions.

Fern

Fern test

Vaginal fluid spread on slide, allowed to dry

Ferm-like crystals seen = positive for amniotic fluid

Detection of semen in vaginal secretions is used for ...

- Sexual assault cases

- Prostate specific antigen

- Acid phosphatase

- Sperm (gram stain)