Lecture 14 - Vaginal fluid analysis
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1
What are the 3 major causes of vaginal discharges/discomfort/ ordor?
Bacterial vaginosis
Candidiasis
Trichomoniasis
Candidiasis
Trichomoniasis
2
These symptoms are positive for which tests?
Bacterial vaginosis
Candidiasis
Trichomoniasis
Bacterial vaginosis
Candidiasis
Trichomoniasis
Bacterial vaginosis - WHIFF (+)
Candidiasis - KOH (+)
Trichomoniasis - WHIFF (+)
Candidiasis - KOH (+)
Trichomoniasis - WHIFF (+)
3
What tests are done to differentiate between conditions?
Wet mount examination
Amine of "whiff" test
Potassium hydroxide (KOH) examination
Gram stain
Amine of "whiff" test
Potassium hydroxide (KOH) examination
Gram stain
4
pH of vaginal secretions (normal) . and why?
3.8-4.5; acidic bc of lactobacilli
5
what does lactobacilli produce?
lactic acid and hydrogen peroxide
6
what does hydrogen peroxide prevent the growth of?
Gardenerella vaginalis
7
Absence of lactobacilli is associated with what condition?
bacterial vaginosis
8
How is a wet mount prepared ? and what should be immediately be reported?
1 stop of saline suspended specimen on slide and cover slip; trichomonas vaginalis
9
How do perform the KOH test?
1 drop of 10% KOH and 1 drop of vaginal suspension; immediatly observe for "fishy" odor.
10
What does KOH do?
digests cellular elements in order to visualize fungal elements (yeasts)
11
What are elements reported in wet mounts?
Red blood cells
White blood cells
Predominant bacterial morphotypes Yeast, hyphae/pseudohyphae Trichomonads
Clue cells
Parabasal cells -
Basal cells
Squamous epithelial cells
White blood cells
Predominant bacterial morphotypes Yeast, hyphae/pseudohyphae Trichomonads
Clue cells
Parabasal cells -
Basal cells
Squamous epithelial cells
12
Are WBC normal is vaginal secretions and when are they high?
yes; during ovulation and menses
13
Are RBCs normal in vaginal secretions?
not usually present unless during menses
14
What cells line the vagina?
strratifies squamous epithelium
15
What are clue cells? and what does its presence indicate?
epithelial cells with numerous bacteria adhere to membranes; indicates bacterial vaginosis
16
Is KOH negative or positive for bacterial vaginosis?
negative but has a fishy smell.
17
Are basal cells seen in normal swab? where are they seen? what does it indicate?
no. ; seen in wet mount with numerous WBCs ; desquamative inflammatory vaginitis.
18
What condition do increased numbers of parabasal cells seen?
atrophic vaginitis and inflammatory vaginitis.
19
What are the results of WHIFF AND KOH for trichomoniasis?
WHIFF - POS
KOH - NEG
KOH - NEG
20
What cells are seen in bacterial vaginosis? AND WHAT IS THE PH
clue cells; absence of lactobacilli ; PH GREATER THAN 4.5
21
What are the WHIFF AND KOH results for bacterial vaginosis?
WHIFF - POS
KOH - NEG
KOH - NEG
22
What is bacterial vaginosis?
lactobacilli replaced by Gardenerella vaginalsis and a faculative anaerobe
23
What is the second most common cause of vagintis?
candidiasis
24
What is seen in the wet mount for candidiasis?
wet mount: yeasts - budding/ pseudohyphae
WHIFF: neg
KOH: pos
WHIFF: neg
KOH: pos
25
What is atrophic vaginitis?
thinning of vaginal epithelium and decrease in glycogen production resulting in dryness, soreness, and spotting. prone to overgrowth of other bacteria ; PH > 4.5
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