Lab dxs: cervicitis and vaginitis

Question 1

Normal vaginal pH? How is pH testing done?

Answer 1

• normal vaginal pH: 3.8-4.5
• this is done with pH paper placed on lateral wall of the vagina
• use pH with range 4.0-5.0

Question 2

What could cause of vaginal pH of greater than 4.5 be?

Answer 2

• bacterial vaginosis, trichomoniasis, and atrophic vaginitis

Question 3

Indications and interfering factors for vaginal wet mount?

Answer 3

• indications: vaginal itching, burning, rash, odor, or d/c
• interfering factors:
  can’t be done during menses, should avoid vaginal meds for 2-3 days prior, vaginal irritation from tampons or intercourse can alter results

Question 4

Technique of vaginal wet mount?

Answer 4

• vaginal secretions are obtained with cotton tipped swab and speculum is used to facilitate obtaining the sample
• sample of vaginal secretions placed on slide with drop of saline and eval. using microscopy
• or can put 1 ml salin in test tube and place swab in test tube to agitate then transfer some over (helps thin secretions)
• slide cover is then placed

Question 5

What cells might be seein in saline wet mount?

Answer 5

• white cells
• clue cells
• lactobacilli
• trichomonads

Question 6

When are white cells seen in wet mount?

Answer 6

normally there should just be a few of them (less than 10)

- should be more epithelial cells than white cells in sample

Question 7

What are clue cells? What does this indicate?

Answer 7

• normal epithelial cells have sharp, distinct borders
• clue cells are vaginal epithelial cells that are covered with bacteria
• clue cells have shaggy borders and the epithelial cells take on a stippled appearance
• this indicates bacterial vaginosis

Question 8

What are lactobacilli? Indication?

Answer 8

• part of normal flora

- there will be less seen with conditions such as yeast and bacterial vaginosis

Question 9

What are trichomonads?

Answer 9

• have small tails, mobile

- WBCs that are seen are slightly smaller than trichomonads

Question 10

Process of KOH prep?

Answer 10

• few drops of 10% KOH soln added to vaginal secretions on microscopic slide
• heating slide will hasten process of destruction of cellular debris
• KOH removes normal cells and bacteria clearing the field so that yeast buds and hyphae may be seen

Question 11

What is the Whiff test?

Answer 11

• when preparing the KOH slide to evaluate for yeast, note whether or not there is an amine (fishy) odor after addition of KOH
• presence of this odor is indicative of bacterial vaginitis
• sensitivity: 67%, specificity: 93% for bacterial vaginosis
• sensitivity 67%, ,specificity 65% for trichomoniasis

Question 12

When is NAAT testing used? Process of this?

Answer 12

• Nucleic acid amplification testing
• for N. gonorrhoeae, C. trachomatis
• swab of vaginal fluid or endocervix
• if unable to obtain above can be done on urine sample
• sensitivity usually well above 90%, specificty usually greater than 99%
• NAATs typically detect 20-50% more chlamydial infections than could be detected by culture or earlier nonculture tests (ID of organism on micro)

Question 13

Process of NAAT urine specimens?

Answer 13

• should be obtained as directed by test manufacturer in package insert or use swab supplied by test manufacturer
• if possible, specimen collection should be delayed for more than 1 hr after pt has voided
• first catch urine (first 10-30 cc voided after initiating stream) should be used