ua 12

vaginitis

common, abnorm discharge, odor, dysuria, dyspareunia, 2nd to bac vaginosis, vulv candid trich, also noninfec conditions

vaginitis dx

saline wet mount, KOH, GS, fresh secretions, litmus pH, dna probe, culture, POC kits

vaginitis collection

polyester plastic swab (no cotton wood or ca algin) vag walls and pool, tube w/ 0.5-1 mL saline & agitated, bio bag, asap

vaginitis specimen handling

rt for Trich vag and N. gon motility, C. trachomatis and HSV fridge to prevent norm flora overgrowth, T. vaginalis <2 hrs

abnorm color and appearance of discharge

increased thin homo white-gray BV, cottage cheese candida, yellow-green frothy adhearent T. vag, yellow-opaque cervical Chlamydia trach

vag pH

4.5 vulvovag candidasis, >4.5 BV, trich, desquamative inflam vag, atrophic vag, 3.8 and 4.5 lactic acid lactobacilli= good

wet prep/KOH vs GS

cells/orgs count quantified at 40x vs reported per 100x oil

wet mount exam

cover slip to exclude air bubbles, lpf scan hpf 40x enumeration, squam epis 25-70 um, polygonal flagstone central nucleus

clue cells

coccobacillus bac clustered on squam epis, shaggy, BV, Gardnerella vag

wbcs

14-16 um, PMNs (multilobed), >3 vag candidiasis, atrophic vag, Trich Clam gon or HSV infec

rbcs

7-8, distorted, norm in menstration or desquamative inflam, distinguish from yeast with KOH

parabasal cells

rare, round-oval, baso granulation (blue blobs), 16-40, in desquam inflam vag with >wbcs

basal cells

basal layer of vag stratified epithelium, 10-16, round not lobed nucleus, abnorm, desquam inflam vag with >wbc and altered flora

bacteria

lactobacillus- large GPR nonmotile lactic acid pH 3.8-4.5, anaerobic & alpha strep, diphtheroids, coag neg staph

lactobacilli replaced by high numbers of

mobiluncus- thin curved GNR motile, prevotella, porphyromonas, bacteroids- anaerobic GNR, G. vag- short GVCB, peptostrep- GPC, entero- GNC, mycoplasma hominis, ureaplasma urealyticum

Trichomonas vaginalis

protozoan, oval, 5-18, 4 atrial flagella, undulating membrane half body, jerky, nonmotile resemble wbcs, viable <2hrs, most be mobile to report

yeast cells

Candida albicans and noncandida, fungal infec, some is norm- budding (blastophores), hyphae, pseudohyph, KOH diff

amine whiff test

fishy amine odor= pos, BV, G. vaginalis with Mobiluncus and T. vag, KOH dissolves epis ad rbc to observe yeast

BV confirmation after amine test

GS, culture, DNA probe, POCT

GS

gold standard for BV orgs, lactobacillus acidophilus, G. vag, bacteroides, mobiluncus, nugent score 0-3 norm, 4-6 intermediate, >7 dx BV

culture

gold stand for yeast and trich, 2 days, diamonds medium, commercial transport and puch system for trich- <30 min incub 5 days 37C CO2

dna testing

hybridization probe for vaginitis org, results in 1 hr, 95% sensitivity, trich w/ amp PCR- most accurate, detects nonviable orgs

POC tests

proline aminopeptidase in secretions for G. vag, OSOM for trich ag from swabs in 10 min blue line and red control= pos

POC- OSOM BVBLUE

vag fluid sialidase, enzymes from Gardnerella, bacteeroides, prevotella, and mobiluncus, 1 min, blue-green= pos, yellow neg

commercial POC tests measure

elevated pH and amine presence

BV

most common vaginitis, 40-50% of child bearing women, due to imbalance in norm flora ratio, malodor and high abnorm discharge after sex

causes of BV

new or many sex partners, douching, intrauteine devices, preg, lack of protective lactobacilli

complications of vag disorders

pelvic inflam disease PID, endometritis, high risk of STIs (HIV, N. gon, C. trach, HSV-2)

vaginal disorders treatment

metronidazole (Flagyl), metronidazol gel, or clindamycin cream

3/4 features must be present to dx BV

thin white homo discharge pH >4.5, pos amine whiff test, clue cells

trichomoniasis

parasitic protozoon, STI, w/ gon or chlamyd, vaginitis in women, urethritis in men (asymp)

trichomoniasis characteristics

green-yellow frothy discharge, malodor, irritation, dysuria, dyspareunia, vag mucosa erythema, strawberry cervix

trichomoniasis dx

wet mount <2 hrs, pH >4.5, wbcs, lactobacilli, amine pos, treat with metronidazole or new tindazole

candidiasis types

C. albicans, glabrata, parapsulosis, tropicalis, krusei, saline/KOH wet prep & GS, confirm with culture and dna hybrid probe

causes of candidiasis

broad spec abx, oral contracep, estrogen replace therapy, hormonal change w/ preg, ovulation, menopause, immunocomp, diabetes mellitus, iron def, HIV, NOT VIA SEX

candidiasis symp

genital itching, burning, dyspareunia, dysuria, thick white curd discharge, norm pH, budding yeast, pseudohyphae, high wbc, lactobacilli, large epi clumps

candidiasis treatment

OTC with butoconazole, clotrimazole, tioconazole, and miconazole, Rx with oral flyconazole or intravag butoconazole nystatin and terconazole

desquamative inflam vaginitis DIV

profuse purulent discharge, erythema, dyspareuniam 2ndary to atrophic vag in post menopaus women, treat with 2% clindamycin, hormone replace therapy

desquamative inflam vaginitis DIV dx

high wbc rbc, some parabasal and basal cells, squam epis, low or no lactovacilli, beta gram pos strep cultured

atrophic vaginitis

postmenopause, thinning of mucosa due to low estrogen and glycogen, altered norm flora, dry, sore, dyspareunia, inflamed mucosa, purulent discharge

atrophic vaginitis dx

micro exam like DIV, treat with estrogen replacement

fetal fibronectin test

fFN- adhesive glycoprotein in extracellular matrix at mom & baby interface, high 1st 24 weeks then gone, if in secretions 24-34 weeks= preterm delivery

symp of preterm delivery

change in secretions, bleeding, contractions, abdominal or back pain, pelvic pressure, cramping

collection of fFN

rotate swab across posterior fornix or vag for 10 secs, ELISA or lateral flow, immunochrom assay rapid cassette (qualitative pos or neg)

fFN pos in symp vs asymp

delivery in 7-14 days vs <34 weeks and 6 days of gestation

premature rupture of fetal membranes

causes infec, detal distress, prolapse of umbilical cord, postnasal endometritis, placental abruption, preterm delivery, amniotic fluid leak

PAMG-1

norm: 0.05-0.22, up to 3 w/ vaginitis, up to 2k-25k: fetal membrane rupture

AmniSure test ROM

qualitative, rapid immediate or <10 min, ummunochrom, collect w/ swab, 2 lines= pos, control line= neg, fridge <6hrs if delay in closed vial

actim PROM

5min, dx POM, rapid (5 min) immunoassay for IGFBP-1 protein, high in amniotic fluid, swab in vag fornix 10-15sec, 2 lines pos

noninterferring contaiminants in actim PROM

blood, urine, semen, bath and odor products, common vag infec, meds

ROM plus

qualitat immunochrom for amniotic fluid in secretions, detects AFP and IGFBP-1 protein (PP12), swab in mucosal lining for 15 secs, pos 2 lines

ROM plus ref

IGFBP-1 in amniotic fluid 10,500-350k ng (100-1,000x higher than in mom serum), serum 55-242 U, AFP in amniotic fluid 2,800-2600ng

wbc quantitation report

<10= rare, <1= 1+, 1-5= 2+, 6-30= 3+, >30= 4+