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 aidthe 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 magnifiion.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 microscopea 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 hyoxide, or KOH, prep. When the vaginal sample was collected,the swab was placeda test tube with approximately half a milliliter of saline. So, for the salineprep, you only have to take a op 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 op of the vaginal sample on another slide and add one op 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. Keepmind 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 cellsfoundthe vagina. They're large, flat cells with a small nucleus and a large area of cytoplasm.Note that there is some granularitythe 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 indie infection. Trichomonads are pearshaped protozoa whichmove by means of flagella. Trichomonads are similarsize 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 itsand. Cluecells are associated with bacterial vaginosis, a conditionwhich the normal microbialflora of the vagina is disrupted. Yeast may be foundtwo 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 yeastsaline, but sometimesit's hidden by epithelial cells or by PMNs. Red blood cells, sperm, and bacteria can alsobe seen.
Vaginitis or vaginal infections with Gabrielle Lany
Vaginal infections are often associated withvaginitis, an inflammation of the vaginal wall characterized by swelling, irritation,discharge and itchiness. The main causes of vaginitis are yeast infectionor candida, bacterial vaginosis, trichomonas and allergic dermatitis. Only trichomonascan be sexually transmitted. In the case of candida vaginitis or bacterialvaginosis, the causes can vary widely, including: antibiotics, hygiene products such as perfumedsoap or bubble bath, certain diseases such as diabetes, as well as sexual intercourse.Basically, these infections result from variationsthe vaginal flora.The symptoms of vaginitis include irritation
of external areas of the genitals, itchy ortingling sensations, redness and sometimes broken skin on the vulva, and especially adense white discharge resembling cottage cheese. The symptoms of bacterial vaginosis includea greyish or yellowish discharge, but it's mainly the fishy smell that characterizesthis infection. You might also experience crampsyour pelvic region, along with rednessand itching of the vulva and the vagina. The symptoms of trichomonas also include avaginal discharge, often greenish or yellowish, a changethe odour of the vaginal discharge,as well as itching, sometimes intense, of the genitals. To diagnose vaginitis, a al examination
is required, along with the patient's detailedmedical history. A number of treatments exist for vaginitisresulting from a yeast infection. Some of them are available without a prescriptionat ugstores. These remedies range from vaginal cream to a single dosepill form. However,if symptoms persist or the overthecounter treatment is not effective, we recommend thatyou see a to obtain a precise diagnosis and determine whether the infection is anSTI. Your partner does not necessarily need a treatment,exceptthe case of trichomonas, or if the infection is persistent, or if he experiencesan irritation on his penis known as balanitis.
Vaginitis is not dangerous on its own, althoughthe irritation that it causes can make you more vulnerable to STIs.Vaginitis does not pose a risk for pregnancy, but as a precaution, we recommend that yousee a to ensure that you receive the appropriate treatment for pregnant women.A few tips on preventing vaginitis: rinse your genitals each day with water, orwash with a gentle pH neutral soap; avoid perfumes and strong soaps;make sure to y your genitals each time after urinating;wash your genitals each time after sexual relations;avoid vaginal douches.
In the case of trichomonas, the rules forpreventing STIs are applicable, that is, use a condom each time you have sex with a newpartner. Treatments are available for recurrent vaginitis,which means, when the infection occurs four or more timesa year. Your can choosethe treatment that's right for you.