vaginal swab analysis Flashcards by skug LU

characterized by abnormal vaginal dis-
charge or odor, pruritus, vaginal irritation,
dysuria, and dyspareunia

Vaginitis

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is secondary to bacterial vaginosis (BV), trichomoniasis, or vulvovaginal candidiasis

vaginitis

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it can occur with noninfectious conditions, such as vaginal atrophy, allergies, and chemical irritation

VAGINITIS

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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)

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is used to identify amniotic fluid
that may be present when the amniotic sac
has rupture

fern test

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what kind of swab is used in a vaginal swab

polyester tipped swab on plastic shaft

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cotton swab is toxic to

Neisseria gonorrhoeae,

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wood in a wooden shaft may be toxic to

Chlamydia trachomatis

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calcium alginate can inactivate

herpes
simplex virus (HSV) for viral cultures

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how much is the saline used in a vaginal swab

0.5 to 1 ml

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Specimens must be kept at room temperature
to

preserve the motility of Trichomonas
vaginalis and the recovery of N. gonorrhoeae,

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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

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When not moving, Trichomonas may
resemble a

white blood cell (WBC),
transitional, or renal tubular epithelial
(RTE) cell.

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Normal vaginal fluid appears

white with a
flocculent discharge.

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ormal vaginal flora includes a predominance
of

large, rod-shaped, gram-positive
lactobacilli and squamous epithelial cells

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increased
thin, homogeneous,
white-to-gray discharge

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white
“cottage
cheese–like” discharge

Candida

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increased yellow-green,
frothy, adherent discharge

T. vaginalis

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yellow, opaque cervical
discharge

C. trachomati

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helps to differentiate the causes
of vaginitis

pH test

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The test should be performed before placing
the swab into saline or KOH solutions.

ph test

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normal ph of vagina

3.8-4.2

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wbc in normal vaginal secretions

rare to 2+

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phh of vaginal disorders

lahat above 4.5 except for candida

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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

presence of clue cells and the absence of WBCs and lacto bacilli morphotypes.

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

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

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

2. AmniSure Test

● Purpose: Detects ruptured membranes

rom plus