Analysis of Vaginal Secretions
bacterial vaginosis, candidiasis, and trichomonas
the three major causes of the most common gynecologic complaints: vaginal discharge, vaginal discomfort, and vaginal odor
wet mount, amine of whiff test, KOH exam, and gram stain
the four direct microscopy tests to differentiate causes of gynecologic complaints
cotton swabs
toxic to Neisseria gonorrheae
wooden shafts
toxic to Chlamydia trachomatis
Dacron swab
used for appropriate collection to obtain vaginal secretions to make sure that pathogen is not killed
3.8-4.5
usual pH of vaginal secretions
4.5
pH associated with bacterial vaginitis, trichomoniasis and atrophic vaginitis
lactobacilli
absence associated with bacterial vaginosis
wet mount
performed immediately to ensure detection of motile Trichomonas vaginalis
10%KOH
used for amine or whiff test
gram stain
performed to detect bacteria
white blood cells
present in vaginal secretions in health, but higher during ovulation and menses
red blood cells
not usually present unless during menses
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
yeast
visualized with KOH prep in order to lyse RBCs; seen on gram stain as gram positive organism
blastoconidium
yeast that can be present in normal vaginal secretions
candidiasis
indicated with increased (1+ or greater) of yeast or presence of hyphae or pseudohyphae
epithelial cells
predominant cell type in wet mounts of healthy vagina
clue cells
formed when numerous bacteria adhere to membranes of epithelial cells; most diagnostic indicator of bacterial vaginosis
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
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
basal cells
abnormal if seen in wet mount; accompanied by numerous WBCs; seen in desquamative inflammatory vaginitis
trichomonads
flagellated protozoans that infect and cause inflammation of vaginal epithelium
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
KOH
digests cellular elements in order to visualize fungal elements
trimethylamine
released from polyamines when pH changes due to KOH produced in bacterial vaginosis in whiff test
bacterial vaginosis
most common cause of vaginal infection due to alteration in normal bacterial flora
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
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
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
atrophic vaginitis
thinning of vaginal epithelium and decrease in glycogen production resulting in dryness, soreness, and spotting; pH greater than 5; treated with estrogen
fetal fibronectin (fFN)
test performed to identify possibility of preterm delivery
50ng/mL of fFN
diagnostic of higher risk of preterm labor
placental alpha microglobulin-1 (PAMG-1)
test performed to identify pregnant women for premature rupture of fetal membranes; increased amount indicates increased risk