Vaginal Secretions - Q&A test

vaginal discharge colors

blood stained, white cream, or greenish

the vagina is lined by non-keratinized squamous epithelial influenced by the hormone?

estrogen and progesterone

The vagina is lined by ________.

nonkeratinized stratified squamous epithelium

vaginal secretion test is for

diagnosis of infection, complication of pregnancy, and forensic studies

normal appearance of vaginal secretion

white, flocculent discharge

normal pH of vaginal secretions

3.8-4.5

normal findings in vaginal secretions

amine test -
wbc -
lactobacilli -
clue cells -
other cells -
other organisms -

amine test - negative
wbc - 2+
lactobacilli - predominant
clue cells - absent
other cells - absent
other organisms - lactobacilli subgroups and occasional yeast

inflammation of the vagina

vaginitis

Painful urination is known as:

dysuria

Painful sexual intercourse is known as

dyspareunia

Vaginitis is characterized by what?

odor, pruritus, vaginal irritation, dysuria, dyspareunia

typical constituents found in vaginal fluid wet mounts are

epithelial cells, wbc, rbc, clue cells, parabasal cells, basal cells

other test for vaginal secretions

fetal fibronectin test and amnisure test

Microscopic methods

wet mount, potassium hydroxide exam, gram stain

Vaginal specimens collected for a saline wet prep should be:
A. Refrigerated to preserve motility
B. Prepared as soon as possible
C. Mailed to a reference laboratory
D. Preserved with potassium hydroxide

B. Prepared as soon as possible

Which of the following would not be a reason to collect a vaginal fluid for analysis?

a. Vaginitis
b. Complications of pregnancy resulting in preterm delivery
c. Forensic testing in a sexual assault
d. Pregnancy testing

d. Pregnancy testing

Which of the following organisms might not be detected if the specimen for vaginal secretion analysis had been refrigerated?

A. Prevotella bivia
B. Lactobacillus acidophilus
C. Trichomonas vaginalis
D. Candida albicans

B. Lactobacillus acidophilus

The appearance of the vaginal discharge in vulvovaginal candidiasis is described as:
A. Clear and colorless
B. Thin, homogeneous white-to-gray discharge
C. White, curd-like
D. Yellow-green and frothy

white, curd-like

Which of the following tests differentiates budding yeast cells from RBCs?

A. pH
B. Saline wet mount
C. KOH prep
D. Whiff test

c. KOH Prep

Which of the following constituents is normal in healthy vaginal fluid secretions?

A. Lactobacilli
B. Basal cells
C. Trichomonas vaginalis
D. Pseudohyphae

A. lactobacilli

A positive amine (Whiff) test is observed in which of the following syndromes?

A. Bacterial vaginosis
B. Vulvovaginal candidiasis
C. Atrophic vaginitis
D. Desquamative inflammatory vaginitis

A. Bacterial vaginosis

A squamous epithelial cell covered with coccobacilli that extends beyond the cytoplasm margin is a:
A. Basal cell
B. Parabasal cell
C. Clue cell
d. Blastospore

c. clue cell

All of the following are diagnostic of bacterial vaginosis except:

a. Vaginal pH of 3.8
b. Presence of clue cells
c. Positive amine (Whiff) test
d. Thin, homogeneous white-to-gray vaginal discharge

a. Vaginal pH of 3.8

Which of the following organisms produces lactic acid and hydrogen peroxide to maintain an acid vaginal environment?
A. Gardnerella vaginalis
B. Mobiluncus spp.
C. Lactobacilli spp.
D. β -Hemolytic streptococci

C. lactobacilli spp.

All of the following are diagnostic of vulvovaginal candidiasis except:
A. Large numbers of WBCs
B. Presence of clue cells
C. Positive KOH test
D. Vaginal pH of 4.0

B. Presence of clue cells

All of the following are diagnostic of trichomoniasis except:
A. Vaginal pH of 6.0
B. Positive amine test
C. Positive KOH test
D. Motile trichomonads present

c. positive KOH test

The bacteria associated with desquamative inflammatory
vaginitis is:
A. β -Hemolytic streptococci
B. Trichomonas vaginalis
C. Gardnerella vaginalis
D. Mycoplasma hominis

A. β -Hemolytic streptococci

The protein present in vaginal secretions that can identify patients who are at risk for preterm delivery is:
A. Human chorionic gonadotropin
B. Estrogen
C. PAMG-1
D. Fetal fibronectin

D. Fetal fibronectin

A 30-year-old woman has symptoms of dysuria, vaginal itching, and a white, curd-like discharge. During hervisit at the Women's Clinic, the patient revealed that she had recently completed a regimen of broad-spectrum antibiotics as treatment for a urinary tract infection. Her health-care provider takes a swab of the vaginal secretions for analysis.

What tests will be performed on the vaginal specimen?

Based on the patient history and observation of the vaginal secretion, which test will be diagnostic for the probable diagnosis?

a. Vaginal pH, saline and KOH wet preps, Gram stain.
b. KOH will reveal budding yeast.

A 30-year-old woman has symptoms of dysuria, vaginal itching, and a white, curd-like discharge. During hervisit at the Women's Clinic, the patient revealed that she had recently completed a regimen of broad-spectrum antibiotics as treatment for a urinary tract infection. Her health-care provider takes a swab of the vaginal secretions for analysis.

a. What confirmatory test can be performed?
b. What is the probable diagnosis?
c. What is the first choice of treatment?

a. Culture and DNA direct hybridization probe (Affirm VPIII).
b. Vulvovaginal candidiasis caused by Candida albicans. c. Antifungal agents.

A sexually active teenager visited the Women's Cliniccom- plaining of vaginal itching and soreness. She indicated that she was experiencing increased vaginal secretions that were frothy and yellow to green. Upon examination, the health- care provider noted a strawberry-like cervix and performed a pH test on the secretions. The pH was 5.5 and the wet prep demonstrated "swimming" organisms.

a. What is the probable diagnosis?
b. What other tests can be performed to confirm this diagnosis?
c. What is the best course of treatment?
d. Should her sexual partner be treated?
e. List three complications that can occur with this disorder.

a. Trichomoniasis caused by Trichomonas vaginalis.
b. Wet mount, vaginal pH, amine test from KOH prep, DNA probe (Affirm VPIII), OSOM Trichomonas Rapid Test.
c. Metronidazole.
d. Yes.
e. Complications include low birth rate, premature rupture of membranes, preterm delivery during pregnancy.

During a routine visit with the gynecologist, a 60-year-old woman complained of vaginal dryness and soreness. During the examination, the health-care provider noted erythema of the vaginal mucosa. The pH of the vaginal secretions was 6.0. The KOH and amine (Whiff) tests were negative. The microscopic examination revealed epithelial cells, basal cells, decreased lactobacilli, and increased gram-positive cocci and gram-negative rods.

a. What is the name of this condition?
b. Explain how this condition can occur.
c. What is the treatment for this condition?

a. Desquamative inflammatory vaginitis secondary to atrophic vaginitis.
b. Reduced estrogen production in postmenopausal women.
c. Hormone replacement therapy (estrogen).

vaginitis is secondary to

- bacterial vaginosis
- vulvovaginal candidiasis
- trichomoniasis

tests for differential diagnosis

litmus pH levels, DNA probe testing, culture, and point of care test kits

What is the finding?

- thin, homogenous, white-to-gray vaginal discharge
- ph >4.5
- wbcs are rare or absent
- lactobacilli rare or absent
- clue cells >20%
- increase in small curved bacilli, coccobacilli, and pleomorphic bacilli
- whiff test positive

bacterial vaginosis

what is the finding?

appearance: white, curd-like
ph: 3.8 - 4.5
wbcs: 3+ to 4+
lactobacilli: present
clue cells: absent
other cells: large clumps of epithelial cells
other organisms: budding yeast cells and pseudohyphae
whiff test: negative

candidiasis

what is the finding?

appearance: yellow-green frothy adherent vaginal discharge increased in volume
ph: >4.5
wbcs: 2+ to 4+
lactobacilli: absent or present
clue cells: absent or present
whiff test: positive

trichomoniasis

what is the finding?

appearance: excessive purulent vaginal discharge, vaginal erythema
ph: >4.5
wbcs: 3+ to 4+
lactobacilli: absent or reduced
clue cells: occasional parabasal or basal cells
other cells: >1+ RBCs
other organisms: 2+ gram-positive cocci
whiff test: negative

desquamative inflammatory vaginitis

what is the finding?

appearance: excessive purulent vaginal discharge, vaginal erythema
ph: >4.5
wbcs: 3+ to 4+
lactobacilli: decreased
clue cells: occasional parabasal or basal cells
other cells: >1+ RBCs
whiff test: negative

atropic vaginitis

a protein used to diagnose ruptured fetal membranes, or fetal fibronectin enzyme

placental a-microglobulin protein 9 (PAMG-1)

how specimen is collected

vaginal swabbing in the vaginal walls and vaginal pool

why cotton swabs should not be used?

it is toxic to neisseria gonorrhea

calcium alginate can inactivate?

herpes simplex virus

after the gross exam, swab is putted in a tube containing

0.5-1.0 mL of sterile physiologic saline

Diluent used

normal saline

other medical history that should be included

menstrual status
use of vaginal creams, lubricants, and douches
recent exposure to sexually transmitted diseases

why specimen must be kept at room temp

to preserve the motility of t. vaginalis and recovery of n. gonorrhoeae

parasites and pathogens which specimen should be refrigerated

c. trachomatis
herpes simplex virus

vaginal flora includes predominance of large, rod-shaped, gram-positive lactobacilli. normal or abnormal?

normal

Cottage cheese discharge should make you think of what diagnosis?

candida infections

factors that can interfere with pH

contamination with cervical mucus, semen and blood

pH is 4.5 indicates

vulvovaginal candidiasis

pH is above 4.5 indicates

bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis, and atrophic vaginitis

provides an acidic vaginal environment

lactic acid

why estrogen production is necessary

to preserve an acidic vaginal environment

objective used for even distribution of cellular components, types and numbers of epithelial cells, clumping of epithelial cells, and the presence of budding yeast

LPO

objective used for cell counting

HPF

typical constituents found in wet mounts

squamous epithelial cells, clue cells, basal cells, parabasal cells, bacteria, yeast, motile t. vaginalis, hyphae/pseudohyphae

25-70 um exhibit a polygonal "flagstone" appearance

squamous epithelial cells

quantitation scheme: less than 10 organisms or cells/slide

rare

quantitation scheme: 6-30 organisms or cells per hpf

3+

quantitation scheme: >30 organisms or cells/hpf

4+

Clumps of epithelial cells on a vaginal specimen can indicate ________________.

increased number of yeast

abnormal variation of the squamous cell and are distinguished by coccobacillus bacteria

clue cells

shaggy appearance

clue cells

diagnostic of bacterial vaginosis

clue cells

measure 14-16 um which often described as polymorphonuclear white blood cells "multi-lobed nucleus"

WBC

>3+ WBCs indicates

vaginitis, trichomoniasis, etc.

7-8 um an can be confused with yeast cells

RBC

RBC might be present during

mens and desquamative inflammatory process

a test used to distinguish rbc and yeast

KOH

round to oval shaped measure 16-40 um

parabasal cells

parabasal cells can be found in patient

menstruating and postmenopausal women

round and measure 10-16 um located deep in the basal layer of the vaginal stratified epithelium

basal cells

comprise the largest portion of vaginal bacteria

lactobacillus spp.

appear as gram-positive nonmotile rods and produce lactic acid

bacteria

maintains the vaginal pH

lactic acid

produced by lactobacilli subgroups which help suppress the overgrowth of the other organisms

hydrogen peroxide

other bacterias found in vagina

anaerobic streptococci, diphtheroids, coagulase-negative staphylococci, a-hemolytic streptococci

thin, curved, gram-negative, motile rods

mobiluncus spp.

Anaerobic Gram Negative Rods

Bacteroides spp.

short, gram-variable coccobacilli

gardnerella vaginalis

Gram positive cocci

Peptostreptococcus spp.

Gram negative cocci

Enterococcus spp.

5-18 um which can cause vaginal inflammation and infection

t. vaginalis

a ____________ tends to appear oval and slightly larger than a wbc

dead trichomonad

Candida albicans and non-candida spp. cause fungal infections

yeast cells

long filaments that grow and form a mycelium

blastophores or hyphae or budding yeast cells

multiple buds that do not detach and form chains

pseudohyphae

yeast cells stain gram?

positive

it is performed by placing a drop of the saline specimen and a drop of 10% KOH solution

amine (whiff) test

The presence of a fishy odor after adding potassium hydroxide to a wet mount slide containing vaginal mucus suggests:
a. bacterial vaginosis.
b. yeast infection.
c. chlamydial infection.
d. pregnancy.

bacterial vaginosis

objective used for examining the presence of yeast pseudophypdae

LPO

objective used to identify smaller blastomeres

HPO

test commonly used to diagnose bacterial vaginosis

amine test

gold standard in identifying the causative organisms for bacterial vaginosis

gram stain

The Nugent score is used to diagnose
A) urinary tract infections.
B) ulcerative colitis.
C) vaginosis.
D) inflammatory colitis.

c. vaginosis

nugent score of 0-3 is considered

normal

nugent score of 4-6 is considered

intermediate

nugent score of 7 or more is considered

diagnostic of bacterial vaginosis