Vaginal Fluid Flashcards
one of the most common conditions diagnosed by health-care providers for female patients, particularly women of childbearing age
Vaginitis
Microscopic methods include a _
saline wet mount examination, potassium hydroxide (KOH) examination
gold standard exam for vaginal secretion
Gram stain
protein to diagnose ruptured fetal membranes, or fetal fibronectin enzyme to assess the risk of preterm delivery
placental a1-microglobulin (PAMG-1)
for specimen collection, may contain antibacterial agents and must not be used
lubricants
The specimen is collected by swabbing the _ to collect epithelial cells along with the vaginal secretions using one or more sterile, _on a plastic shaft or swabs specifically designated by the manufacturer.
vaginal walls and vaginal pool
;polyester-tipped swabs
Cotton swabs should not be used because cotton is toxic to
Neisseria gonorrhoeae,
the wood in a wooden shaft may be toxic to
Chlamydia trachomatis
calcium alginate can inactivate _ for viral cultures
herpes simplex virus (HSV)
The health-care provider performs a gross examination of the vaginal secretions and then places the swab in a tube containing _ of sterile physiologic saline
0.5 to 1.0 mL
Thin, homogeneous, white- to-gray vaginal discharge
bacterial vaginosis
White, curd-like vaginal discharge
“cottage-cheese like”
candidiasis
Yellow-green frothy adherent vaginal discharge increased in volume
trichomoniasis
Excessive purulent vaginal discharge, vaginal erythema
desquamative inflammatory vaginitis
atrophic vaginitis
candidiasis has pH of
3.8 - 4.5
bacterial vaginosis has _ clue cells
> 20%
Large clumps of epithelial cells are present in
candidiasis
Occasional parabasal or basal cells
> 1+ RBCs
desquamative inflammatory vaginitis
atrophic vaginitis
Budding yeast cells and pseudohyphae can be seen in
candidiasis
2+ gram- positive cocci
desquamative inflammatory vaginitis
positive in amine test (whiff)
bacterial vaginosis
trichomoniasis
Specimens must be kept at room temperature to preserve the motility of _ and the recovery of _
Trichomonas vaginalis; N. gonorrhoeae
Specimens for T. vaginalis should be examined within _ hours of collection
2
_ and _ must be refrigerated to prevent overgrowth of normal flora
C. trachomatis and herpes simplex virus
normal vaginal flora includes a predominance of large, rod-shaped, gram-positive _ and _
lactobacilli; squamous epithelial cells
t/f. wbc and rbc may be present if px if menstruating
true
normal appearance of vaginal secretions
White, flocculent discharge
normal pH of vaginal secretions
3.8 - 4.2
normal amine (whiff) test of vaginal secretions
neg
normal wbcs of vaginal secretions
2+
normal lactobacilli of vaginal secretions
predominant
normal clue cells of vaginal secretions
absent
lactobacilli produces the end product _ from glycogen metabolism. _ provides an acidic vaginal environment with a pH value between 3.8 and 4.5
lactic acid
Some lactobacilli subgroups also produce _, which is toxic to pathogens, and helps keep the vaginal pH acidic to provide protection from urogenital infections.
_ has been associated with the absence of hydrogen peroxide–producing lactobacilli
hydrogen peroxide
Bacterial vaginosis
_ production also is necessary to preserve an acidic vaginal environment
estrogen
used as a confirmatory examination for yeast or bacterial vaginosis
gram stain
Less than 10 organisms or cells/slide
rare
6 to 30 organisms or cells/hpf
3+
a polygonal “flagstone” appearance. They contain a prominent centrally located nucleus about the size of a red blood cell and a large amount of irregular cytoplasm, lacking granularity, with distinct cell margins
Squamous epithelial cells
25-70 μm
abnormal variation of the squamous epithelial cell; granular, irregular appearance sometimes described as “shaggy.”
clue cells
diagnostic of bacterial vaginosis caused by G. vaginalis
clue cells
rbc in diameter
wbc in diameter
7-8 um
14-16 um
RBCs can be confused with yeast cells and are distinguished from yeast cells by _, which will lyse the RBCs but allow the yeast cells to remain intact.
KOH
marked basophilic granulation or amorphic basophilic structures (“blue blobs”) in the surrounding cytoplasm
parabasal cells
16-40 um
located deep in the basal layer of the vaginal stratified epithelium
basal cells
10-16 um
appear as large gram-positive, nonmotile rods on Gram stain and produce lactic acid, which maintains the vaginal pH at 3.8 to 4.5
Lactobacillus spp.
t/f.
Other bac- teria commonly present include anaerobic streptococci, diph- theroids, coagulase-negative staphylococci, and a-hemolytic streptococci.
atrial flagellated protozoan that can cause vaginal inflammation and infection in women. The organism is oval shaped, measures 5 to 18 μm in diameter, and has four anterior flagella and an undulating membrane that extends half the length of the body
Trichomonas vaginalis
Trichomonas vaginalis motion
jerky
cause most fungal infections
Candida albicans and non–Candida spp.
yeast appear as both:
- budding yeast cells (blastophores)
- hyphae
multiple buds that do not detach and form chains, can also be seen
pseudohyphae
t/f. Lactobacillus acidophilus (large gram-positive rods), G. vaginalis and Bacteroides spp. (small gram-variable or gram- negative rods), and Mobiluncus spp. (curved gram-variable rods).
true
gold standard test for detecting yeast and Trichomonas
culture
Special media called _ is required for T. vaginalis.
Diamond’s medium
developed to specifically identify the causative pathogen for vaginitis
DNA hybridization probe methods
dna testing is easy to perform and results are available in _ hour with a sensitivity of 95%
1
affecting 40% to 50% of women of childbearing age.1 BV occurs when there is an imbalance in the ratio of normal vaginal bacterial flora
bacterial vaginosis
Patients may present with a “straw- berry cervix” because of punctuate hemorrhages.
Trichomoniasis
Trichomoniasis is classified as an STI, frequently occurs with _, and has been associated with enhanced transmission rates of _.
gonorrhea and Chlamydia infections; HIV
syndrome found in postmenopausal women. This syndrome is caused by thinning of the vaginal mucosa because of reduced estrogen production and decreased glycogen production.
Atrophic Vaginitis
