Vaginitis Candida BV Trichomoniasis Wet Mount Whiff Test Vaginal pH Trich Albicans gardnerella
Distinguished future physicians welcome toStomp on Step 1 the only free tutorials series that helps you study more efficiently by focusingon the highest yield material. I'm Brian McDaniel and I will be your guide on thisjourney through vulvovaginal infections. This is the 3rd tutorial in my playlist covering allof microbio. Vulvovaginitis (AKA Vaginitis) is inflammationof the lower genital tract. It is usually due to infection, but there are a wide varietyof causes. During this tutorial we will focus on the 3 most important causes of vulvovaginitisfor the medical board exam (trichomonas, candida and BV). However, you should know that othertypes of vaginitis include mechanical irritation,
allergic reactions (to soaps or feminine products)and a variety of other infections. Atrophic Vaginitis is a common cause of vaginitis inpostmenopausal women and we will cover that in a later tutorial in the GYN section. Gonorrheaand Chlamydia present primarily with cervicitis, but it can also cause vulvovaginitis. GCwill be covered later in its own tutorial. We will start with a few different tests thatwe will use to differentiate between the different infections.Wet Prep (AKA Wet Mount Test) is a microscopic examination of vaginal discharge used to differentiatebetween different types of vulvovaginitis. The vaginal specimen is obtained using a speculumand a que tip similar to how one gets a pap
smear. Then the specimen is rubbed onto aglass slide. One half of the slide has a drop of saline added to it while the other halfof the slide has a drop of 1020% KOH (Potassium hydroxide) added to it.When Saline is added it makes it easier to view clue cells for BV flagellated motilecells for trichomonas. The KOH kills bacteria and vaginal cells leavingonly yeast cells. This makes it easier to view the psuedohyphae and budding yeast presentduring vulvovaginal candidiasis. KOH is also alkalotic so it can be used fora â€œWhiff Test.â€� In this scenario when the alkalotic KOH is added to a sample containingBV it will create an amine or fishy smell.
This is a similar principle behind how thesmell of BV can increase after unprotected sex since semen is alkalotic. The normal vaginal pH for a reproductive agewoman is about 4, while the normal vaginal pH before puberty and after menopause is about7. During puberty there is an estrogen guided increase in the growth lactobacilli flora.These bacteria break down glycogen into lactic acid which lowers pH from about 7 to about4. Now that you know the normal values you can apply it to diseases. Usually, BacterialVaginosis Trichomonas have alkalotic pH (gt;4.5 in reproductive age women) while candidahas normal pH (lt;4.5). pH paper can be tested
by using pH paper on vaginal discharge. You can see here at the top right corner thatI give BV a high yield rating of 3 on a scale from 1 to 10. If you want to learn more about that ratingsystem you can go to my website or click on this orange box here if you are watching thistutorial on a computer. Bacterial Vaginosis (AKA BV) is a polymicrobialinfection caused by the overgrowth of normal flora. The key bacteria in this infectionis gram negative Gardnerella Vaginalis. Clue cells are visible on the saline portionof a wet prep. A Clue Cell is a sloughed mucosal
squamous epithelial cell covered in many adherentcoccoid bacteria (Gardenerella Vaginalis). Here is a picture comparing normal squamousepithelial cells with a few scattered lactobacill to squamous cells that are covered in thousandsof adherent garenerella bacteria. Here is one more pic. You can see on the leftwe have a normal squamos epithelial cell with a few WBCs. On the right we have the darkerClue cells. Finally I have a photomicrograph to look atin case you see that on your test. A thinwatery graywhite discharge is presentA fouls smell is present and often described as an Amine Odor or Fishy Smell. This smellis intensified after unprotected intercourse
DIY 48 Second Test for Candida
Did you know 65% of people in America todayhave Candida overgrowth, which is a yeast overgrowth, in an infection in your body thatplagues you, people don't even know they have it. I'm here with Crista Orekio, and she makespeople feel a lot better that necessarily don't know they ever have it, and she tellsthem exactly what to do, and she lays out step by step program that you can get ridof Candida in your body well. So on today's tutorial, she's actually going to show us a selfdiagnostictool that you could do from home in a simple as whaté 2 minutesé Less than that. For 6days in a row to really know if you have Candida. I'm gonna do it. I'm actually a little bitnervous coz your telling me that 3 of the
foods that people eat all the time that actuallyfeed these nasty creatures in your body righté Yah. people have it all the time. And I thinkit's on your list when your consuming this food huhé Definitely except for one of them,i'm not really a big beer drinker. Did I actually give one of them awayé You did. Alright. It'salright. So let's talk about the other one. The food that's feeding your Candida in amoment let's talk about those. But first, tell me really how dirty and grimly this littlething in your body, could you paint a real vivid picture for meé Yah. Well Candida isa, it's a chronic infection. It's something out living in your system that needs to befed. Yah. and when we get this overwhelming
food cravings, it's not really us cravingthe food, it's Candida organisms that's over grown and these is not just limited to women.A lot of times you hear it with women, but its men too. All you have to do is have aone round of full spectrum antibiotics through your life, and you can get this Candida overgrowth,and I said i've seen it among 2 of every 3 of my clients. And it contributes to adrenalfatigue, chronic exhaustion and digestive complaints, lifelong digestive complaints,weather its constipation, bloating and depression. 'Coz digestive health and mental health areinextricably connected, and also, on thyroid health. There are 2 Million Americans withthyroid problems, can be healed by getting
rid of these crazy organisms. Did you say75% reduction in getting colon cancer soon as you get rid of Candidaé Yah. you can slashyour lifetime chances of colon cancer by getting rid of Candida by 75%. So let's talk aboutthe test, test you for Candida, what do you thinké Your doing this on cameraé were doingit on camera. I'm a little bit nervous. I'm not. Well your asking these guys to test sohere we go. Here we go. Drew's gonna be the guinie pig. And if you get me offended byspitting on a cup, close your eyes. Okay. So here we go. Okay so what do we have todo, first thing in the morning, you go ahead and spit, first thing when you wake up inthe morning, is you fill up a glass of water,
halfway, before you eat or drink anything,before you brush your teeth, and then you spit, about a dime size amount, that's abouta quarter righté Yah. Your a cheater. So you spit in a glass and then you watch it 2 or3 times for 45 minutes before your getting ready for work. You wanna know if it sinksto the bottom, yah, if it does, there's more of them than you, does it grow legs, or doesit stay for a long timeé if it does anything but floating on top, then you should probablyclean yourself of Candida. But you have to do it 6 days in a row, of here included, butyou can put out and clean them. So if your going to commit to this, hit the green buttonon or in fitlife.tv, wherever your
viewing this, because were gonna see if wehave this. Were gonna do this for 6 days. It's looking right, we got some legs, growthhere, you just stick around, were gonna come back to that in a moment okayé Now let's getinto what foods people eat that they don't know feed this little critters that are takingaway your life in your world and in your joy in your health okay. And 3 food, or theseare drinks that you may be craving, that maybe it's the Candida craving it, and not necessarilyyou. Its adding to these infection that just won't go away. Yah and one of them is a kicker.Like one of them I drink everyday that I didn't even know that feeds Candida. That soundsto be a healthy drink and stuff. It shocks
Examination of Vaginal Wet Preps
music It's a typical day. A patient has noticedsome itching, or maybe an unpleasant vaginal odor. During her exam, the ian willcheck vaginal pH, examine any discharge that's present, and collect a sample. Then, it'son to the microscope. music This is where you'll gather more specificinformationabout what's causing those vaginal symptoms. We'll show you how to prepare andexamine vaginal wet preps and how to do a whiff test. The results, combined with the patient's vaginal pH test, will aid in the diagnosis.
Under the microscope, you'll be looking for trichomonads, yeast, and the clue cells associated with bacterial vaginosis. We'll show you how to recognize them. music First, the microscope itself: This is a compoundlight microscope. It has several objective lenses on a rotating mount. For our purpose,one of these has to be a 10x low power objective, and one has to be a 40x for greater magnification.This flat part, under the objectives, is the stage. Under the stage is the condenser. Belowthat, at the base of the microscope, is the light source. There are two knobs that controlfocus; one for coarse adjustment and one for
fine adjustment. And these are the oculars,or eyepieces. We'll come back to the microscope in a minute, but first, let's look at how to prepare wet mount slides. The complete vaginal wet mount involves botha saline prep and a potassium hydroxide, or KOH, prep. When the vaginal sample was collected,the swab was placed in a test tube with approximately half a milliliter of saline. So, for the salineprep, you only have to take a drop of the suspension and place it on a slide. Add acoverslip, being careful to avoid trapping air bubbles. Your saline slide is ready.Place a second drop of the vaginal sample on another slide and add one drop of 10 percentKOH. Sniff the preparation immediately, using
your hand to waft any odor toward your nose.This is the whiff test. Note if there's a fishy or amine odor. Then add a coverslip,avoiding air bubbles. Keep in mind that you must work quickly to prepare and examine thewet mounts. That's because trichomonads may lose their characteristic motility within15 to 20 minutes. Before we move on now, though, let's lookat the cast of characters you may discover. These are normal squamous epithelial cellsfound in the vagina. They're large, flat cells with a small nucleus and a large area of cytoplasm.Note that there is some granularity in the cytoplasm.
Polymorphonuclear leukocytes are known asPolys, or PMNs. They may also be called white blood cells, or WBCs. These are small roundcells. Several lobes of the nucleus are visible within the surrounding cell cytoplasm. Findingmany PMNs may indicate infection. Trichomonads are pearshaped protozoa whichmove by means of flagella. Trichomonads are similar in size to PMNs and are identifiedby their characteristic jerking movement. The actual flagella may be too thin and toorapidlymoving to be seen. A clue cell is a squamous epithelial cellcoated with enough small bacteria that at least 75 percent of the cell's border is obliterated.It may look as if someone has spread glue
over the cell and pressed it in sand. Cluecells are associated with bacterial vaginosis, a condition in which the normal microbialflora of the vagina is disrupted. Yeast may be found in two forms. Pseudohyphaeare the long, tubular, branching forms. Budding yeast are paired yeast cells that resemblea shoe print. The larger part is the sole and the smaller bud is the heel of the shoe. The saline prep will allow you to see epithelialcells, PMNs, trichomonads, and clue cells. You can also see yeast in saline, but sometimesit's hidden by epithelial cells or by PMNs. Red blood cells, sperm, and bacteria can alsobe seen.