Vaginal Secretions

3 major causes of discharge, discomfort, and odor

• Bacterial vaginosis

• Candidiasis

• Trichomoniasis

The 3 causes are differentiated by direct microscopy test:

• wet mount

• KOH

• gram stain

Specimen collection procedure…

collected by dacron swab, place in saline solution, and send to lab ASAP

Usual vaginal pH

3.8 - 4.5

Healthy vaginal bacteria are…

lactobacillus

Lactobacillus produces….

lactic acid and H2O2

The absence of lactobacillus is associated with…

bacterial vaginosis

Normal bacterial flora seen in wet prep is lactobacillus. How do they appear?

Large, slender rods

WBC are present in normal vaginal secretions but higher levels present during…

ovulation and menses

Clue cells are a diagnostic indicator of bacterial vaginosis. How do they appear?

Epithelial cells with bacteria adhering to the membrane, covering at least 75%

KOH is also known as the whiff test, why?

a “fishy” odor = trimethylamine. Released from polyamines when pH changes due to KOH

KOH digests cellular elements, making the visualization of … elements easier

fungal

What yeast is responsible for majority of candidiasis cases?

Candida albicans

What is seen in wet mount and KOH?

Budding yeast, pseudohyphae, and increased WBC

What test is positive in Trichomoniasis?

Amine

Atrophic Vaginitis occurs when…

peri-menopausal and postmenopausal women. Due to a decrease in estrogen production

What happens in Atrophic vagintis?

Vaginal epithelium is thinned, glycogen production is decreased —→ resulting in decrease in lactobacilli

So how is Atrophic Vaginitis treated?

estrogen replacement

Fibronectin

A glycoprotein found on cell surfaces, in plasma and amniotic fluid

When is fetal fibronectin (fFN) produced?

Produced during pregnancy, during labor the cellular adhesion is disrupted —→ we see it in amniotic fluid

If we see fFN, this could indicate…

preterm labor

What test is used to detect the Placental Alpha Microglobulin 1 (PAMG-1)?

ROM test

What does the detection of PAMP-1 mean in ROM test?

Detecting premature rupture of amniotic membrane