Laboratory Diagnostics

Question 1

Vaginal pH testing

1. What is the normal vaginal pH?
2. This is done with pH paper on what part of the vagina?
3. Use pH paper with a range of what?
4. What often causes a vaginal pH higher than 4.5? 3

Answer 1

1. The normal vaginal pH is 3.8 to 4.5
2. This is done with pH paper placed on the lateral wall of the vagina
3. Use pH paper with a range of 4.0-5.0
4. • Bacterial vaginosis,
   • trichomoniasis
   • atrophic vaginitis

Question 2

Vaginal wet mount
1. Indications? 5

2. Interfering factors? 3

Answer 2

1. Indications
   - Vaginal itching,
   - burning,
   - rash,
   - odor or
   - discharge
2. Interfering factors
   - Cannot be done during menses
   - Should avoid vaginal meds for 2-3 days prior
   - Vaginal irritation from tampons or intercourse can alter the results

Question 3

Vaginal Wet Mount Technique
1. Vaginal secretions are obtained how?

2. Sample of vaginal secretions placed on a slide with a drop of what and evaluated using microscopy?
3. Or can put 1 ml of ______ in a test tube and place swab in the test tube to agitate then transfer some to the slide
4. when is this technique helpful?

Slide cover is then placed

Answer 3

1. with a cotton tipped swab and a speculum is used to facilitate obtaining the sample
2. saline
3. saline
4. (helpful with copious discharge to help thin the secretions so individual cells can be seen)

Question 4

Microscopic evaluation of the saline wet mount

4

Answer 4

1. White cells
2. Clue cells
3. Lactobacilli
4. Trichomonads

Question 5

1. Normally how may white cells should there be?

2. What should there be more of?

Answer 5

1. Normally there should just be a few white cells (less than 10 in the high power field)
2. There should be more epithelial cells than white cells in a sample

Question 6

1. Normal cells have what kind of borders?
2. What are clue cells?
3. What do they look like?
4. What does this indicate?

Answer 6

1. Normal epithelial cells have sharp, distinct borders
2. Clue cells are vaginal epithelial cells that are covered with bacteria
3. Clue cells have shaggy borders and the epithelial cells take on a stippled appearance
4. =Bacterial vaginosis

Question 7

1. What are lacobacilli a part of?

2. In what conditions will we see less of them? 2

Answer 7

1. Lacobacilli are part of the normal flora
2. There will be less seen with conditions such as
   - yeast and
   - bacterial vaginosis

Question 8

Trichomonads

1. What structure do they have that identifies them?
2. How will you notice them on the slide?
3. Compare their size to WBCs?

Answer 8

1. Black arrows denote the trichomonads. Note the small tails seen
2. These are mobile and zoom around the slide (heat the slide and they will move more)
3. WBCs seen are slightly smaller than the trichomonads

Question 9

KOH (potassium hydroxide)
1. A few drops of what solution is added to vaginal secretions on a microscope slide?

2. Heating the slide will hasten the process of what?
3. The potassium hydroxide removes what clearing the field so that what may be seen?

Answer 9

1. 10% potassium hydroxide
2. destruction of cellular debris but the test may be completed without heating
3. normal cells and bacteria, yeast buds and hyphae

Question 10

Whiff test with KOH
1. When preparing the KOH slide to evaluate for yeast, note whether or not there is a what?

2. The presence of this odor is indicative of what?
3. Sensitivity 67%, Specificity 93% for what?
4. Sensitivity 67%, Specificity 65% for what?

Answer 10

1. an amine (fishy) odor after the addition of the KOH
2. bacterial vaginitis
3. bacterial vaginosis
4. trichomoniasis

Question 11

Nucleic Acid Amplification Testing (NAAT)

1. For what? 2
2. Swab for this where? 2
3. If you can’t obtain the above what should you do?
4. NAATs typically detect 20%–50% more _________ infections than could be detected by culture or earlier nonculture tests (identification of the organism on micro)

Answer 11

1. For
   - N. gonorrhoeae and
   - C. trachomatis
2. Swab of the
   - vaginal fluid or
   - endocervix
3. If unable to obtain the above can be done on a urine sample
4. chlamydial

Question 12

NAAT urine specimens
Specimens should be obtained as directed by the test manufacturer in the package insert and use the swab supplied by the test manufacturer

1. If possible, specimen collection should be delayed until how long after the patient has voided?
2. Which type of specimen should be used?

Answer 12

1. > 1 hour

2. First-catch urine (e.g., the first 10–30 cc voided after initiating the stream) should be used