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
Urinary Tract Infections 5
Op. Gotta pee. (door closing) (zipper unzipping) There are three things I wanna tell you about urine. (intro: slam and discreet cough) Lesson one, there is a system responsible for discharging urine. It does not include the vagina. Urine is producedthe kidneys, it comesdown two tubes called the ureters,
it's heldthe bladder and then exits throughthe urethraa hole called the meatus. Most meatuses are loed herethe vulvain between the vagina and the clitoris and here on the penis at the glans or head. And then because no body is the same, we've got meatuses that are sometimes loed here and here and here and here. Note, none of these holes are the vagina. Many people think that vaginas are theexit point for urine, but they're not. Not typically anyway.
So why do people think that urine leaves the body via the vagé Perhaps they weren't taught, or didn't learn. Perhaps they think that the vagina isthe opposite of the penis and therefore since urine comes out of the penis thenit must come out of the vagina. Or maybe because they sit down on the toilet, urinate, and it feels like it's coming out of their vagina. Lesson two, there aren't usually germsthe urinary tract. Germs do attack the urinary tract by goingthrough the meatus up the urethra.
This is commonly referred to as a urinary tract infection, or a UTI. Some people call it the quot;Honeymoon Diseasequot;. Why do they call it thaté Because when a newlywed couple is gettingsloppy, there are bodily fluids everywhere that transmit the bacteria from the anus to the vagina. Now you've just been told. Ok. It's incredibly painful. You'll feel the urge to pee, you'll go to the bathroomand nothing will come out except maybe a trickle.
This sensation will persist,minutes later the same process again. Then you add feeling feverish, nauseous, achy. If you finally do get anything out of yoursystem, it's cloudy and pungent smelling. Oh, and it burns. So you're ready to get help. When you do, the might say something like quot;You've got a urinary tract infection,here's a prescription for antibiotics. Take these and you'll feel better soonquot;.
And you might reply, quot;Oh no, I don't want to putantibioticsmy system, no unnecessary things here. I don't want to create a giant superbugthat's going to be ug resistantquot;. And the might say, quot;If you don't dowhat I recommend, you'll probably be crawling backhere tomorrow much worse.quot; And you might take the prescription, surrendering to the excruciating, inflamed irritation between your legs. Okay, so a few hours later,you go to the bathroom again, and you think it's going to be this agonizing pain but it's not,