Vaginal secretions

Vaginitis

is one of the most common conditions diagnosed by health-care providers for female patients, particularly women of childbearing age.

bacterial vaginosis(BV), trichomoniasis, or vulvovaginal candidiasis;

Most often, vaginitis is secondary to

Gram stain

which is considered the gold standard microscopic methods

saline wet mount examination, potassium hydroxide (KOH) examination, and the Gram stain

Microscopic methods for vaginal secretions

Bacterial vaginosis

Thin, homogeneous, white-togray vaginal discharge

Candidiasis

White, curd-like vaginal discharge

Trichomoniasis

Yellow-green frothy adherent vaginal discharge increased in volume

Desquamative inflammatory vaginitis and atrophic vaginitis

Excessive purulent vaginal discharge, vaginal erythema

3.8-4.5

Ph of candidiasis

Bacterial vaginosis, trichomoniasis, inflammatory, atrophic

Clinical features with >4.5 ph

Bacterial vaginosis, trichomoniasis

Clinical feature positive to amine test

Bacterial vaginosis

Increase in small curved bacilli, coccobacilli, and pleomorphic bacilli

Candidiasis

Budding yeast cells and pseudohyphae

Inflammatory

2+ gram-positive cocci

Atrophic

Increased grampositive cocci and gram-negative rods; decreased large rods

Candidiasis

Has Large clumps of epithelial cells

Inflammatory and atrophic

Occasional parabasal or basal cells >1+ RBCs

Trichomoniasis

WBCs with 2+ to 4+

Candidiasis, inflammatory, atrophic

WbCs with 3+ to 4+

bacterial vaginosis

>20% clue cells are indicative of

Candidiasis

Present lactobacilli indicates

Atrophic

Decreased lactobacilli indicates

Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus

Cotton swabs should not be used because cotton is toxic to ___, the wood in a wooden shaft may be toxic to ____, and calcium alginate can inactivate ____ for viral cultures

0.5 to 1.0 mL of sterile physiological saline

The health-care provider performs a gross examination of the vaginal secretions and then places the swab in a tube containing

pH paper

Specimens should be tested with ____before being placed in saline

one to two drops of normal saline solution, 10% KOH

An alternative method of specimen preparation is to dilute a sample of vaginal discharge in ___directly on a microscope slide. Then a second sample is placed in ___solution in the same manner.

room temperature, Trichomonas vaginalis and the recovery of N. gonorrhoeae, C. trachomatis, refrigerated

Specimens must be kept at ___ to preserve the motility of ___, whereas specimens for ___ and HSV must be ___ to prevent overgrowth of normal flora.

2 hours

Specimens for T. vaginalis should be examined within___of collection

white blood cell (WBC), transitional, or renal tubular epithelial (RTE) cell.

When not moving, Trichomonas may resemble a

White, flocculent discharge

Normal appearance of vaginal sec

3.8 - 4.2

pH of vs

Lactobacilli

Predominant bacteria normal in vagina

cervical mucus, semen, and blood

Factors that can interfere with the pH test include contamination of the vaginal secretions with

Lactic acid

provides an acidic vaginal environment with a pH value between 3.8 and 4.5

Mobiluncus, Prevotella, and Gardnerella vaginalis,

acidity suppresses the overgrowth of infectious organisms such as

Estrogen and hydrogen peroxide

Other factors that is necessary to preserve an acidic vaginal environment

hydrogen peroxide

Bacterial vaginosis has been associated with the absence of

Saline wet mounts and KOH

Initial screening test for vaginal infection

Gram stain

is used as a confirmatory examination for yeast or BV

high power field (hpf) (40×)

For wet mount examinations, cells and organisms are quantified per

oil immersion field (100×)

for Gram stains, cells and organisms are reported per

Low

What objective is used when the slide is scanned for an even distribution of cellular components, types and numbers of epithelial cells, clumping of epithelial cells, and the presence of budding yeast or pseudohyphae

High

What objective is used when the organisms and cells are counted

Intravaginal medications

might leave oil droplets that can interfere with the interpretation of wet mounts

Gram stain

Intravaginal medications might leave oil droplets that can interfere with the interpretation of wet mounts. In this case, a ___ is useful to detect yeast or BV.

25 to 70 µm in diameter

Squamous epithelial cells measure

Squamous

exhibit a polygonal "flagstone" appearance

Squamous

They contain a prominent nucleus that is centrally located and about the size of a RBC, as well as a large amount of irregular cytoplasm, lacking granularity, with distinct cell margins

linings of the vagina and female urethra

Squamous cells originate from the

Clue cells

are an abnormal variation of the squamous epithelial cell

coccobacillus bacteria

Clue cells are distinguished by

75%

Bacteria should cover at least ___ of the epithelial cell

Clue cells

This gives the cell a granular, irregular appearance sometimes described as "shaggy."

Clue cells

are diagnostic of BV caused by G. vaginalis

14 to 16 µm in diameter

WBCs measure

4+

>30 organisms or cells/hpf

3+

6-30 organisms or cells/hpf

2+

1-5 organisms or cells/hpf

1+

Fewer than 1 organism or cell/hpf

Rare

Fewer than 10 organisms or cells/slide

RBC

appear as smooth, nonnucleated, biconcave disks measuring approximately 7 to 8 µm in diameter

T

T or f

Usually RBCs are not seen in vaginal secretions

HOH

RBCs can be confused with yeast cells and are distinguished from yeast cells by

Parabasal cells

are round to oval-shaped and measure 16 to 40 µm in diameter.

16-40

Parabasal cells are round to oval-shaped and measure

Parabasal cells

marked basophilic granulation or amorphic basophilic structures ("blue blobs") in the surrounding cytoplasm.

1:1 to 1:2

NC ratio of parabasal cells

DIV

Increased numbers of parabasal cells, if present with large numbers of WBCs, can indicate

Parabasal cells

less mature cells may be found if the patient is menstruating or if the patient is postmenopausal

Basal cells

are located deep in the basal layer of the vaginal stratified epithelium

Luminal squamous ep

Parabasal cells are located in

10 to 16 µm in diameter

Basal cells measures

1:2

NC ratio of basal cells

Round

Basal cells are distinguished from WBCs, which are similar in size, by their

Lactobacillus

appear as large, gram-positive, nonmotile rods

anaerobic streptococci, diphtheroids,

coagulase negative staphylococci, α-hemolytic streptococci

Other bacteria commonly present in vagina

Mobiluncus

thin, curved, gram-negative, motile rods

T. vaginalis

is an atrial flagellated protozoan that can cause vaginal inflammation and infection in women

5-18

Vaginalis measures

Vaginalis

The organism is oval shaped, measures 5 to 18 µm in diameter, and has four anterior flagella and an undulating membrane that extends half the length of the body

Axostyle

bisects the trophozoite longitudinally and protrudes from the posterior end, which enables the organism to attach to the vaginal mucosal and cause tissue damage

Jerky

Movmmt of vaginalis

WBC

nonmotile trichomonads can be mistaken for

Candida albicans

cause most fungal infections, but an occasional yeast in vaginal secretions is considered part of the normal flora

Positive

Yeast cells stain gram

Fishy odor

KOH Preparation and Amine Test is reported as positive when there is presence of

trimethylamine

Fishy odor results from ___, a volatilization product of amines, when the KOH is added

anaerobic

Increased numbers of ___ bacteria in the vagina produce polyamines that are released into the vaginal fluid.

BV, G. vaginalis in conjunction with Mobiluncus spp. and with T. vaginalis

Because volatile amines are not present in normal vaginal secretion, a positive test result suggests ___ caused by increased numbers of ____

10% glycerin

One drop of ___ may be added after the KOH to prevent specimen deterioration

Lactobacillus acidophilus

large gram-positive rods

G. vaginalis and Bacteroidesspp.

small gram-variable or gram-negative rods

0

if 4+ Lactobacillus morphophytes are present on Gram stain, and Gardnerellaand Bacteroides spp. morphophytes and curved gram-variable rods are absent, the score is

Nugent gram stain

Criteria to Diagnose Bacterial Vaginosis

Culture

is the gold standard test for detecting yeast and Trichomonas

G. vaginalisis

Culture for ____not diagnostic for BV because it is part of the normal flora in 50% of healthy women.

Diamond medium

is required for determining the presence of T. vaginalis.

30 minutes , 5 days at 37°C

Vaginalis must be inoculated into the pouch within ___of collection and then is incubated for ___ in a CO2atmosphere.

PCR

This is the most accurate diagnostic method, and it has the advantage of detecting nonviable organisms

BV

is associated with new or multiple sex partners, frequent douching, use of intrauterine devices, pregnancy, and a lack of the protective lactobacilli