Analysis of Vaginal Secretions

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1

bacterial vaginosis, candidiasis, and trichomonas

the three major causes of the most common gynecologic complaints: vaginal discharge, vaginal discomfort, and vaginal odor

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wet mount, amine of whiff test, KOH exam, and gram stain

the four direct microscopy tests to differentiate causes of gynecologic complaints

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cotton swabs

toxic to Neisseria gonorrheae

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wooden shafts

toxic to Chlamydia trachomatis

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Dacron swab

used for appropriate collection to obtain vaginal secretions to make sure that pathogen is not killed

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3.8-4.5

usual pH of vaginal secretions

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4.5

pH associated with bacterial vaginitis, trichomoniasis and atrophic vaginitis

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lactobacilli

absence associated with bacterial vaginosis

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wet mount

performed immediately to ensure detection of motile Trichomonas vaginalis

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10%KOH

used for amine or whiff test

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gram stain

performed to detect bacteria

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white blood cells

present in vaginal secretions in health, but higher during ovulation and menses

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red blood cells

not usually present unless during menses

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large lactobacilli rods

account for 50-90% of microbes of healthy vagina; nonmotile, gram-positive that produce large amounts of lactic acid; responsible for acidic environment

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yeast

visualized with KOH prep in order to lyse RBCs; seen on gram stain as gram positive organism

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blastoconidium

yeast that can be present in normal vaginal secretions

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candidiasis

indicated with increased (1+ or greater) of yeast or presence of hyphae or pseudohyphae

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epithelial cells

predominant cell type in wet mounts of healthy vagina

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clue cells

formed when numerous bacteria adhere to membranes of epithelial cells; most diagnostic indicator of bacterial vaginosis

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75%

percentage of cell surface covered with bacteria for it to be called a clue cell; bacteria must also extend beyond cell's cytoplasmic borders

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parabasal cells

not present in normal vaginal samples; increased in menses or postmenopausal period; seen in atrophic vaginitis and desquamative inflammatory vaginitis; oval to round with small NC ratio (1:1-2) 15-40um

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basal cells

abnormal if seen in wet mount; accompanied by numerous WBCs; seen in desquamative inflammatory vaginitis

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trichomonads

flagellated protozoans that infect and cause inflammation of vaginal epithelium

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trichomonas vaginalis

has an optimal growth at 6.0 pH and prefers anaerobic environment; identified by jerky movement due to four anterior flagella and undulating membrane; nonmotile or dead resemble WBCs

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KOH

digests cellular elements in order to visualize fungal elements

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trimethylamine

released from polyamines when pH changes due to KOH produced in bacterial vaginosis in whiff test

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bacterial vaginosis

most common cause of vaginal infection due to alteration in normal bacterial flora

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Gardnerella vaginallis

overgrowth along with a facultative anaerobe and replaces lactobacilli leading bacterial vaginosis, most common cause of vaginal infection: foul discharge, presence of clue cells; pH usually greater than 4.5

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Candidiasis (albicans)

second most common cause of vaginitis; part of normal flora, but overgrowth causes pH and normal flora changes; curdlike discharge; revealed through wet mount and KOH; normal pH and amine test negative

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trichomoniasis

most common parasitic gynecologic infection; transmitted sexually, humans are only host; pH 5-6; numerous clumped WBCs, mixed bacterial flora, positive whiff; DNA probe

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atrophic vaginitis

thinning of vaginal epithelium and decrease in glycogen production resulting in dryness, soreness, and spotting; pH greater than 5; treated with estrogen

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fetal fibronectin (fFN)

test performed to identify possibility of preterm delivery

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50ng/mL of fFN

diagnostic of higher risk of preterm labor

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placental alpha microglobulin-1 (PAMG-1)

test performed to identify pregnant women for premature rupture of fetal membranes; increased amount indicates increased risk