LECTURE 12 (Vaginal swabs)

Question 1

What are vaginal swabs used in?

Answer 1

Gynaecological examinations to screen for infections
- Bacterial vaginosis
- Yeast infections
- Sexually transmitted infections (STIs)

Question 2

What are the different causes of vaginal discharge?

Answer 2

• Cervical secretion in response to hormonal levels during the menstrual cycle
  [increased mucous production from the cervix at the time of ovulation]
• Pregnancy + Oral contraceptive use
  [Increase]
• Endometrial, cervical and vaginal cancer
• Infections
  [Candidal infection, Bacterial vaginosis, Trichomonas, N. gonorrhea, Chlamydia]

Question 3

What are the main symptoms of vaginal pathologies?

Answer 3

• Vulvar itching
• White cheesy vaginal discharge
• Superficial dyspareunia and dysuria
• Vulval oedema
• Vulval excoriation
• Redness + erythema

Question 4

When should Pap smears be performed?

Answer 4

• Midcycle
  [to prevent contamination from menstrual flow]
• During pregnancy or immediately postpartum
• All women between 25-64

Question 5

What are the high-risk factors for cervical dysplasia?

Answer 5

• Human Papillomavirus (HPV) infection
• Early onset of sexual activity, having multiple sexual partners/a partner with a history of multiple sexual partners
• Smoking
• Chlamydia
• Long-term used of oral contraceptives
• Immunocompromised individuals

Question 6

When do you stop routine screening?

Answer 6

• If a woman has had regular screening with normal results + over 65
• Women who have had a total hysterectomy for non-cancerous conditions + do not have a history of high-grade cervical precancerous lesions/cervical cancer

Question 7

What preparation should be done before taking the Pap test?

Answer 7

• Plan the test 10-20 days after the first day of last menstrual period
• Refrain from using vaginal creams, foams or medications for at least 48 hours before the test
• Avoid douching
• No sex for at least 24 hours

Question 8

What are the different Pap test results?

Answer 8

• Normal Pap test results
  [no abnormal cervical cells]
• Atypical squamous cells of undetermined significance (ASC-US)
  [some cells don’t look completely normal, not clear if caused by HPV infection]
• Atypical glandular cells (AGC)
  [some glandular cells were found that do not look normal]
• Low-grade squamous intraepithelial lesions (LSIL)
  [low-grade changes usually caused by a HPV infection]
• Atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H)
  [some abnormal squamous cells were found that may be a high-grade squamous intraepithelial lesion]
• High-grade squamous intraepithelial lesions (HSIL)
  [moderately/severely abnormal cervical cells that could become cancer if not treated]
• Adennocarcinoma in situ (AIS)
  [advanced lesion found in glandular tissue of cervix -> pre-cancer that can become cancer]