vaginal swab analysis Flashcards
characterized by abnormal vaginal dis-
charge or odor, pruritus, vaginal irritation,
dysuria, and dyspareunia
Vaginitis
is secondary to bacterial vaginosis (BV), trichomoniasis, or vulvovaginal candidiasis
vaginitis
it can occur with noninfectious conditions, such as vaginal atrophy, allergies, and chemical irritation
VAGINITIS
diagnose ruptured fetal membranes, or fetal fibronectin enzyme to assess the risk of preterm delivery
detect the placental α -microglobulin
(PAMG-1) protein, insulin-like growth 1 factor
binding protein-1 (IGFBP-1)
is used to identify amniotic fluid
that may be present when the amniotic sac
has rupture
fern test
what kind of swab is used in a vaginal swab
polyester tipped swab on plastic shaft
cotton swab is toxic to
Neisseria gonorrhoeae,
wood in a wooden shaft may be toxic to
Chlamydia trachomatis
calcium alginate can inactivate
herpes
simplex virus (HSV) for viral cultures
how much is the saline used in a vaginal swab
0.5 to 1 ml
Specimens must be kept at room temperature
to
preserve the motility of Trichomonas
vaginalis and the recovery of N. gonorrhoeae,
specimens for ____ and ___ must
be refrigerated to prevent overgrowth of
normal flora
specimens for C. trachomatis and HSV must
be refrigerated to prevent overgrowth of
normal flora
When not moving, Trichomonas may
resemble a
white blood cell (WBC),
transitional, or renal tubular epithelial
(RTE) cell.
Normal vaginal fluid appears
white with a
flocculent discharge.
ormal vaginal flora includes a predominance
of
large, rod-shaped, gram-positive
lactobacilli and squamous epithelial cells
increased
thin, homogeneous,
white-to-gray discharge
BV
white
“cottage
cheese–like” discharge
Candida
increased yellow-green,
frothy, adherent discharge
T. vaginalis
yellow, opaque cervical
discharge
C. trachomati
helps to differentiate the causes
of vaginitis
pH test
The test should be performed before placing
the swab into saline or KOH solutions.
ph test
normal ph of vagina
3.8-4.2
wbc in normal vaginal secretions
rare to 2+
phh of vaginal disorders
lahat above 4.5 except for candida
increase in small curved bacilli, coccobacilli and pleomorphic bacilli
bacterial vaginosis
has budding yeast and pseudohyphae
candidiasis
2+ gram + cocci
div
increased gram + cocci and gram - rods decreased large rods
atrophic vaginits
positive amine whiff test
BV, and Trichomoniasis
excessive purulent diascharge and vaginal erythema
DIV, AND ATROPHIC VAGINITIS
HAS LARGE CLUMP OF EPITHELIAL
CANDIDIASIS
OCCASIONAL PARABASAL OR BASAL CLELS AND >1 RVC
DIV AND AV
DIFFERENCE OF FIV AND AV
DIV has 2+ gram + cocci as compared to AV which has gram + cocci, gram - rods, and some large rods
rovides an acidic vaginal
environment with a pH value between 3.8
and 4.5
Lactic acid
acidity suppresses the overgrowth of
infectious organisms such as
Mobiluncus,
Prevotella,
Gardnerella vaginali
helps keep the vaginal pH acidic to provide protection from uro genital
infections.
h2o2
provides an acidic vaginal
environment with a pH value between 3.8
and 4.5
Lactic acid
____ and ___ are
the initial screening tests,
Saline wet mounts and KOH mounts are
the initial screening tests,
is used as a confirmatory
examination for yeast or BV.
Gram stain
wet mount examinations, cells and organisms
are quantified per
high power field (hpf)
(40×);
Gram stains, cells and organisms are
reported per
oil immersion field (100×).
quanttative scheme for microscopic examination
rare = fewer than 10 organisms or cell/slide
1+ =fewer than 1 cell/hpf
2+ = 1=5
3+ = 6-3
4+ = >30
exhibit a polygonal “flagstone” appearance.
Squamous Epithelial Cells
arge, flat cells originate from the linings of
the vagina and female urethra and are
present in significant numbers in the vaginal
secretions of a healthy female
Squamous Epithelial Cells
Clumps of epithelial cells are indication of
the presence of increased numbers of yeast
abnormal variation of the squamous epithelial
cell
Clue Cells
distinguished by coccobacillus bacteria
attached in clusters on the cell surface,
spreading past the edges of the cell and
making the border appear indistinct or
stippled.
Clue Cells
granular, irregular appearance sometimes
described as “shaggy.”
Clue Cells
granular cytoplasm. Often described as
polymorphonuclear (PMN) WBCs due to their
multilobed nucleus
White blood Cells
rbc is indicative of
menstruation or desquamative
inflammatory process
can be confused with yeast cells
RBC
RBC DIFF FROM YEAST
e dis
tinguished from yeast cells by KOH, which
will lyse the RBCs but allow the yeast cells to
remain intact.
● round to oval-shaped
Parabasal Cells
marked basophilic granulation or amorphic
basophilic structures (“blue blobs”)
Parabasal Cells
Some less mature cells areseein in
menstruating and postmenopausal.
Parabasal Cells
Increased numbers of parabasal cells, if
present with large numbers of WBCs, can
indicate
DIV
not normally seen in vaginal fluid and, if
present and accom panied by large numbers
of WBCs and altered vaginal flora, can
suggest DIV
Basal Cells
ROUND SILA
atrial flagellated protozoan that can cause
vaginal inflammation and infection in women
T. vaginalis
“jerky” motion of the flagella and undulating
membrane characteristic
T. vaginalis
A tends to appear oval and
slightly larger than a WBC.
dead trichomonad
ODOR FROM WHIFF TEST IS DUE TO
TRIMETHYLAMINE
Increased numbers of anaerobic bacteria in
the vagina produce _______that are
released into the vaginal fluid.
polyamines
_____ may be added after
the KOH to prevent specimen deterioration.
One drop of 10% glycerin may be added after
the KOH to prevent specimen deterioration.
gold standard test for detecting yeast and
Trichomonas;
Culture
sa bv yuung gram stain
is
required for determining the presence of T.
vaginalis.
● Cult
Diamond medium
have been developed to identify the specific
causative pathogen for vaginitis
DNA TEST
detects vaginal fluid sialidase,enzyme produced by the bacterial
pathogens associated with BV, such
as
Gardnerella,
Bacteroides,
Prevotella, and Mobiluncus
OSOM BVBLUE test
blue or green is positive, yellow is
negativ
immunochromatographic strip test
that detects T. vaginalis antigen from
vaginal swabs in 10 minutes
OSOM Trichomonas Rapid Test
risk factor
● for the premature rupture of membranes and
preterm labor for pregnant women
BACTERIAL VAGINOSIS
Additional complications include
● pelvic inflammatory disease and endometritis,
as well as an increased risk for acquiring
some sexually transmitted infections (STIs)
such as HIV, N. gonorrhoeae, C. trachomatis,
and HSV-2
bv
presence of
clue cells and the absence of WBCs and
lacto bacilli morphotypes.
bv
According to Amsel’s Diagnostic Criteria,
three of the following four features must be
present for the diagnosis of BV:
1.
Thin,
white,
homogeneous
discharge
2. Vaginal fluid pH greater than 4.5
3. A positive amine (whiff) test
4. Presence of clue cells on
microscopic examination
- Thin,
white,
homogeneous
discharge - Vaginal fluid pH greater than 4.5
- A positive amine (whiff) test
- Presence of clue cells on
microscopic examination
treatment of bv
menidazole
transmitted by sexual intercourse, and it
causes vaginitis in women and, sometimes,
urethritis in men
TRICHOMONIASIS
a green-to-yellow frothy vaginal discharge,
malodor,
pruritus,
irritation,
dysuria,
dyspareunia, and vaginal mucosa erythema,
although some patients are asymptomatic
TRICHOMONIASIS
a “straw berry cervix” because of punctuate
hemorrhages.
TRICHOMONIASIS
Most yeast infections are caused by
C.
albican
is part of the normal vaginal flora,
but an infection occurs when there is a
change in the vaginal environment that
permits the overgrowth of ___ and
symptoms of the infec tion to occur
Candida
Mostly found in women of childbearing age
who are produc ing large amounts of
estrogen.
candidiasis
microscopic examination of the saline and
KOH wet prep and Gram stain will reveal
budding yeast and pseudohyphae forms,
large numbers of WBCs, lactobacilli, and
large clumps of ep ithelial cells
candidiasis
decreased estrogen
div
large numbers of WBCs, RBCs, occasional
parabasal and basal cells, squamous
epithelial cells, and reduced or absent
lactobacilli that have been replaced by
gram-positive cocci
div
treated by 2% clindamycin
div
● Syndrome found in postmenopausal women
atrophioc vaginitis
caused by thinning of the vaginal mucosa
because of reduced production of both
estrogen and glycogen
Atrophic Vaginitis
include vaginal dryness and soreness,
dyspareunia, inflamed vaginal mucosa, and
purulent discharge. The vaginal secretion pH
is greater than 4.5, and the amine test is
negative
Atrophic Vaginitis
includes large numbers of WBCs
and the presence of RBCs, occasional
parabasal and basal cells, squamous
epithelial cells, and decreased numbers of
lactobacilli that have been replaced by
gram-positive cocci and gram-negative rods.
atrophic vaginitis
Treatment
● estrogen replacement.
● Topical vaginal ointment
atrophic vaginitis
Patient history, amniotic pooling in the fornix of the
vagina, a vaginal pH greater than 7.0, and a positive
fern test are strong indicators of
amniotic sac
rupture
Preterm delivery,
Fetal Fibronectin Test
pinclude a change in
vaginal secretions, vaginal bleeding, uterine
contractions, abdominal or back discomfort,
pelvic pressure, and cramping
rpeterm delivery
Predicts risk of preterm labor
Rapid fFN (Fetal Fibro nectin Test)
: Detects rupture of fetal
membranes
- AmniSure Test
● Purpose: Detects ruptured membranes
rom plus
