Vaginal Secretions (Textbook) Flashcards
Vaginitis
One of the most common conditions diagnosed by health-care providers for female patients, particularly women of childbearing age.
Usually, vaginitis is secondary to bacterial vaginosis (BV), vulvovaginal candidiasis, or trichomoniasis; however, vaginitis can also occur with non-infectious conditions such as vaginal atrophy, allergies, and chemical irritation.
Microscopic Examination
A saline wet mount examination, potassium hydroxide
(KOH) examination, and the Gram stain, which is considered the gold standard.
Purpose of Examining Vaginal Secretions
- Infections
- Detect the placental a-microglobulin (PAMG-1) protein to diagnose ruptured fetal membranes
- Fetal fibronectin enzyme to assess the risk of preterm delivery
Vaginal Secretion Specimen Collection
- Polyester-tipped swabs on a plastic shaft
- Cotton swabs: toxic to Neisseria gonorrhoeae
- Wooden shaft: toxic to Chlamydia trachomatis
- Calcium alginate: inactivates herpes simplex virus (HSV) for viral cultures
Vaginal Secretions: pH Testsing
Specimens should be tested with pH paper before being placed in saline.
Paper with a narrow pH range is recommended to more accurately evaluate pH values in the 4.5 range.
- pH about 4.5: women with vulvovaginal candidiasis
- pH above 4.5: women with bacterial vaginosis, trichomoniasis, desquamative inflammatory vaginitis (DIV), and atrophic vaginitis.
Specimen Handling by Suspected Organism
- Trichomonas vaginalis: Kept at room temperature to preserve the motility, and should be measured within two hours of collection
- N. gonorrhoeae: Kept at room temperature to aid recovery
- C. trachomatis: Kept refrigerated to prevent overgrowth of normal flora
- Herpes simplex virus: Refrigerated to prevent overgrowth of normal flora.
Maintenence of Acidic Vaginal pH
Lactic acid from Lactobacillus provides an acidic vaginal environment with a pH value between 3.8 and 4.5.
Estrogen production also is necessary to preserve an acidic vaginal environment.
Vaginal Secretion Wet Mount Findings
- Squamous epithelial cells
- White blood cells
- Red blood cells (differentiated form yeast by adding KOH wich will lyse RBCs)
- Clue cells
- Parabasal cells
- Basal cells
- Bacteria
- Motile Trichomonas vaginalis
- Yeast
- Hyphae/pseudohyphae
Parabasal Cells
- Round to oval shaped and measure 16 to 40 µm in diameter.
- N/C ratio is 1:1 to 1:2, with marked basophilic granulation or amorphic basophilic structures (“blue blobs”) in the surrounding cytoplasm.
- Located in the luminal squamous epithelium of the vaginal mucosa
Basal Cells
Basal cells are located deep in the basal layer of the vaginal stratified epithelium.
If present and accompanied by large numbers of WBCs and altered vaginal flora can suggest desquamative inflammatory vaginitis.
“Whiff” Test
Collection swab rolled onto a slide and add one drop of 10% KOH solution. The slide is immediately checked for a “fishy” amine odor produced by volatilization of
amines when the KOH is added.
OSOM Trichomonas Rapid Test
The OSOM Trichomonas Rapid Test is an immunochromatographic strip test that detects T. vaginalis antigen from vaginal swabs in 10 minutes.
Yeast Infection
Predominantly found in women of childbearing age, who are producing large amounts of estrogen. Estrogen causes the vagina to mature and produce glycogen, which facilitates the growth and adherence
of C. albicans.
Desquamative inflammatory vaginitis (DIV)
Syndrome characterized by profuse purulent vaginal discharge, vaginal erythema, and dyspareunia.
Multiple causes of DIV, β-hemolytic gram-positive streptococci can be cultured from most patients.
DIV is treated with 2% clindamycin or hormone replacement therapy (effective for patients with DIV secondary to atrophic vaginitis)
Atrophic Vaginitis
Syndrome found in postmenopausal women. This syndrome is caused by thinning of the vaginal
mucosa because of reduced estrogen production and decreased glycogen production. As a result, the vaginal environment changes and the balance of normal flora is altered.
