vaginal secretions

atrophic vaginitis

syndrome in postmenopausal women caused by reduced estrogen production

bacterial vaginosis (BV)

inflammation of the vagina caused by Gardenerella vaginalis

basal cells

cells located in the basal layer of the vaginal stratified epithelium

clue cells

squamous epithelial cells covered with the gram-variable bacteria Gardenerella vaginalis

desquamative inflammatory vaginitis (DIV)

syndrome characterized by purulent vaginal discharge, vaginal erythema, and dyspareunia

dyspareunia

abnormal pain during sexual intercourse

dysuria

painful urination

Gardnerella vaginalis

rod-shaped bacteria that causes bacterial vaginitis

lactobacilli

group of gram-positive rod-shaped bacteria

Mobiluncus spp.

curved, gram-variable, rod-shaped bacteria

parabasal cells

cells located in the luminal squamous epithelium of the vaginal mucosa

pruritus

symptom of itching

Trichomonas vaginalis

flagellated protozoan that infects the vagina

Tricomoniasis

vaginal infection caused by T. vaginalis

Vaginal pool

mucus and cells in the posterior formix of the vagina

vaginitis

inflammation of the vagina; vaginal discharge, vulvar itching, and irritation and odor

vulvovaginal candidiasis

inflammation of the vulva, vagina, or vulvovaginal glands caused by Candida albicans

normal vaginal secretion

clear to white; odorless high viscosity

normal flora

lactobacilli

lactobacilli converts

glycogen → lactic acid which maintains acidic vaginal pH and produces H2O2 which kills harmful bacteria and viruses

vaginal pH

3.8 - 4.5

vaginitis is most common in

women of child-bearing age

Causes of vaginitis

BV, yeast infection, STD

specimen collected from

lateral wall of the vagina; no lubricants

device used

sterile, dacron swab

DONT use ____ or ____ for swabs

cotton, toxic to N. gonorrhoeae; wood, toxic to C. trachmoatis

When to transport sample to lab

ASAP - within 30 minutes; but 2 hours is acceptable

store specimen in

room temp

Why timing is important?

Longer the time the less positive wet mount specimen is

BV lab findings

pH: > 4.5
discharge: white-gray, thin-viscosity, homogeneous
odor: positive (fishy)
microscopic: clue cells; no-rare WBCs

Trichomoniasis lab findings

pH: > 4.5
discharge: yellow, green, frothy, high-volume
odor: positive (fishy)
microscopic: trich present; absent>present lactobacilli;

Candida vulvovaginitis lab findings

pH: 4.0-4.5
discharge: white, “curd”-like
odor: absent
microscopid: budding yeast/pseudohyphae, 3-4+ WBCs, lactobacilli present

atrophic vaginitis

pH: > 4.5
discharge: purulent vaginal discharge, vaginal erythema
odor: absent
microscopic: 3-4+ WBCs, lactobacilli decrease, occasional basal cells, >1+ RBCs

saline wet mount

prep clean glass slide
place one drop of vaginal specimen on slide
cover slide with a cover slip, remove air bubbles
examine slide with 10x objective for ECs and any budding yeast cells/pseudohyphae
examine slide on 40x and quantify organisms and cells per hpf

amine (whiff) test

apply one drop of saline vaginal swab to surface of clean glass slide
add one drop of 10% KOH to sample
hold slide in one hand and gently waft towards nose and assess for “fishy” odor

amine odor occurs from

volatilization of amines when KOH is added

KOH prep for vaginal specimens

prep clean glass
one drop of specimen on slide
add one drop of 10% KOH
allow KOH to prep for about 5 min
cover with cover slip, remove air bubbles
examine under 10x for yeast pseudohyphae
examine under 40x for budding yeast cells

trichomoniasis causes

vaginitis in women and urethritis in men

trich frequently occurs with…

gonorrhea and chlamydia infections

trich in pregnant women

low birth weight, premature rupture of membranes, preterm delivery

DNA probe

OSOM

DNA culture

POCT specific for:

trichomonas vaginalis, candida albicans, gardnerella vaginalis

POCT

add sample buffer to tube
insert swab and mix
stand for 1 min.
remove swab
insert test stick into sample
read results in 10 min

Fetal fibronectin test

adhesive glyoprotein in extracellular matrix at maternal and fetal interface w/in uterus

fetal fibrionectin is elevated

during first 24 weeks of pregnancy; presence = preterm delivery

PROM

premature rupture of fetal membranes

AmniSure ROM test

qualitative immunochromatographic device

Actim PROM

rapid immunoassay