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 tutorialmy 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 thata later tutorialthe GYN section. Gonorrheaand Chlamydia present primarily with cervicitis, but it can also cause vulvovaginitis. GCwill be covered laterits 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 op of saline added to it while the other halfof the slide has a op of 1020% KOH (Potassium hyoxide) 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 increasethe 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;4.5reproductive 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 bacteriathis 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 coveredmany adherentcoccoid bacteria (Gardenerella Vaginalis). Here is a picture comparing normal squamousepithelial cells with a few stered lactobacill to squamous cells that are coveredthousandsof 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
Gardnerella vaginalisanimated quick
Gardnerella vaginalis is a pleomorphic bacteriawhich is the principle organism responsible for the common complaints of bacterial vaginosis.Bacterial vaginosis is the most common cause of vaginal infectionchild bearing womancaused by an overgrowth of bacteria within the vaginal canal which resultsgreyishdischarge and fishy odor. The diagnosis is made using KOH prep where a foul smell canbe appreciated as a positive whiff test. Additionally under microscopic examination, characteristicepithelial cells coveredbacteria called clue cells, indies a positive diagnosis.Bacterial vaginosis is not a sexually transmitted disease that can be passed to sexual partnersbut is often associated with sexual activity.
Bacterial vaginosis is treated with metronidazolefor symptomatic improvement.
What is trichomoniasis
Trichomonasvaginalis is responsible for a sexually transmitted infection known as trichomoniasis and as we'll talk abouta minute, the symptoms mainly occurin womenthe vagina. Now this STI is not caused by a bacterium, but rather a protozoan which is a more advancedform of microorganism
than a bacterium and this protozoanspecifically is a parasite and it exists mainly by eating cells that they destroy, soeating cell fragments and this protozoan usesthese cell fragments or these pieces of cells for nourishment. Now they typically havea pear shape to them, so I'll aw this pear shape here.
So this is their body, the cell body. These trichomonas, or youcan also refer to them as trichomonads have one cell to them, so this is the one cell pear body and they move around becauseof these protein strands, these whips that they have, that are called flagella, flagella. And finally, one of theother things you might see
if you take a look at thisguy under a microscope, as we willa minute, is the nucleus. So here's the nucleus. Now because trichomoniasis is a sexually transmitted infection, we have to consider themode of transmission, or how does it commonly spread from one person to the other,
and as the name sort of sugggests, this occurs only through vaginal sex and what makes thisinfection very interesting is that the trichomonadprotozoan can't survive anywhere else. So they can only livewithin the urogenital tract. Now this means they can live within women, likethe vaginaltract orthe urethra,
or they can also livemen, but the tricky thing about that with men is that they rarely have symptoms. So they're asymptomatic, which means that they'recarriers of this infection. So they're asymptomatic carriers that can spread this STI to women without even realizing it.