Lab Diagnostics Flashcards
normal vaginal pH
3.8 - 4.5
pH paper is placed on the ________________ of the vagina
lateral wall
use pH paper with a pH range of
4.0 - 5.0
what conditions often have a pH > 4.5
- bacterial vaginosis (> 4.5)
- trichomoniasis (5.0 - 6.0)
- atrophic vaginitis
indications for a vaginal wet mount
vaginal
- itching
- burning
- rash
- odor
- discharge changes
Interfering factors of a vaginal wet mount
- cannot be done during menses
- should avoid vaginal meds 2-3 days prior to wet mount
- vaginal irritation from tampons or intercourse can alter the results
vaginal wet mount technique
use speculum - swab vaginal secretions
place secretions onto slide, use drop of saline, examine under microscope
can also use 1mL of saline in test tube and place swab into test tube - this is used when vaginal secretions are too thick to put onto slide; use saline to dilute secretions before examining under microscope
(with slide cover on top)
what can you see on microscopic evaluation of saline wet mount
- white cells
- clue cells
- lactobacilli
- trichomonads
WHITE CELLS
should just be a few white cells (WBCs)
should be more squamous epithelial cells present than white cells on sample
CLUE CELLS ARE INDICATIVE OF
BACTERIAL VAGINOSIS
what are clue cells
clue cells are vaginal epithelial cells covered in bacteria
what do clue cells look like
Normal epithelial cells have sharp, distinct borders
Clue cells have shaggy borders and the epithelial cells take on a stippled appearance
lactobacilli are
NORMAL!
part of the normal vaginal flora
there will be less lactobacilli seen in conditions such as
yeast & bacterial vaginosis
TRICHOMONADS
have tails
are mobile - zoom around on the slide
trichomonads are slightly larger than WBCs on slide
KOH PREP
A few drops of10% potassium hydroxide solution is added to vaginal secretions on a microscope slide
Heating the slide will hasten the process of destruction of cellular debris but the test may be completed without heating
The potassium hydroxide removes normal cells and bacteria clearing the field so that yeast buds and hyphae may be seen
KOH PREP is testing for
yeast (fungal) infection
what are you looking for on KOH prep
budding yeast & branching hyphae
KOH whiff test
When preparing the KOH slide to evaluate for yeast, note whether or not there is an amine (fishy) odor after the addition of the KOH
The presence of this odor is indicative of bacterial vaginitis
- could be either bacterial vaginosis or trichomoniasis
KOH whiff test has same _____________ for bacterial vaginosis & trichomoniasis, but is more _______________________ for ___________
sensitivity
but KOH whiff test is more specific for bacterial vaginosis than trichomoniasis
PCR TESTING
NAAT = NUCLEIC ACID AMPLIFICATION TESTING
test for gonorrhea & chlamydia
NAAT is testing for ________ & __________
gonorrhea & chlamydia
NAAT can use what samples
vaginal, cervical, or urine
but is more sensitive/specific for vaginal & cervical samples; if cannot obtain those, can do urine
Swab of the vaginal fluid or endocervix
If unable to obtain the above can be done on a urine sample
NAATs typically detect 20%–50% more chlamydial infections than could be detected by culture or earlier nonculture tests (identification of the organism on micro)
NAAT urine sample
want first-catch instead of clean catch
Specimens should be obtained as directed by the test manufacturer in the package insert and use the swab supplied by the test manufacturer
First-catch urine (e.g., the first 10–30 cc voided after initiating the stream) should be used
NAAT urine sample should be read __________ after voiding
> 1 hr
