high vaginla swabs

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Mohammad Umer Medical Lab Technology 3rd year student from rawalpindi medical college (14 jan 2011)

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High Vaginal SwabsIn microbiology section : 

High Vaginal SwabsIn microbiology section Mohammad Umer MLT 3rd year Rawalpindi Medical College

High vaginal swabs : 

High vaginal swabs High vaginal swabs are use to diagnose the Vaginosis Vaginitis Becterial vaginosis is the most common cause of vaginal infection. It is not transmettied throw sexually. But more common in those female who are sexually active Bectrial vaginosis is caused by an imbalance of naturally occurring bacterial flora and should not be confused with yeast infection (candidiasis), or infection with Trichomonas vaginalis (trichomoniasis), which are not caused by bacteria

Normal Flora of Normal Vagina : 

Normal Flora of Normal Vagina Facultative Anaerobes NF Streptococcus 20% Enterococcus 28 Staph aureus 2-10 Lactobacillus 100 Gardnerella 70 Corynebacterium 40 Enterobacteriaceae 18 Neisseria/Haemophilus X

Normal Flora of Normal Vagina(cntd..) : 

Normal Flora of Normal Vagina(cntd..) Anaerobes NF Bacteroides fragilis 4-40 Prevotella/Porphyromonas 12-33 Fusobacterium 7-28 Clostridium/Eubacterium 0-13 Actinomyces X Peptostreptococcus low Propionibacterium 0-8

Causes of Vaginal infections : 

Causes of Vaginal infections Type of Vaginitis: Etiology/comments Allergic Latex, sperm, douching, hygiene products Atrophy: Estrogen deficiency Chemical irritatio: Soaps, Hygiene products Foreign Body with or w/o infection or trauma: Tampons, pessary or other contraceptive device Bacterial Vaginosis: Gardnerella, Chlamydia, S.G(AB) Trichomoniasis: Tricamonas Vaginalis Vulvovaginal candidiasis: C. albicans, glabrate, tropicalis

Most common types of Vaginitis : 

Most common types of Vaginitis Bacterial vaginosis. Candida or "yeast" infection. Trichomoniasis vaginitis. Chlamydia. Gonococcal vaginitis. Viral vaginitis. Non-infectious vaginitis.

Bectrial vaginosis : 

Bectrial vaginosis Replacement of normal Lactobacillus sp. in the vagina with high concentrations of anaerobic bacteria Cause of microbial alteration is not fully understood. Associated with multiple sex partners, douching, and lack of lactobacilli. Up to 50% of women with BV may not report any symptoms.

Slide 8: 

BV-associated Flora

Slide 9: 

Bacterial Vaginosis Thin, homogeneous, white discharge that coats the vaginal walls Presence of clue cells on micro examination pH of vaginal fluid >4.5 A fishy odor of vaginal discharge before or after treatment with KOH solution (whiff test)

Other Bacteria : 

Other Bacteria Organisms such as E. coli, Klebsiella, and Enterococcus are part of the endogenous flora or are present as fecal contaminants and do not cause vaginitis Culture for or reporting the presence of these organisms, e.g., is inappropriate and will lead to unnecessary antimicrobial therapy But it should be reported when the female is pregnant

Lab investigations of becterial vaginosis : 

Lab investigations of becterial vaginosis To make a diagnosis of bacterial vaginosis, a speculum examination and subsequent swabs from high in the vagina should be obtained. These swabs should be tested for(Amsel's criteria): A characteristic "fishy" odor on wet mount. This test, called the whiff test, is performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge. A characteristic fishy odor is considered a positive whiff test and is suggestive of bacterial vaginosis.

Lab investigations of becterial vaginosis : 

Lab investigations of becterial vaginosis Loss of acidity. To control bacterial growth, the vagina is normally slightly acidic with a pH of 3.8–4.2. A swab of the discharge is put onto litmus paper to check its acidity. A pH greater than 4.5 is considered alkaline and is suggestive of bacterial vaginosis. The presence of clue cells on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge. These are epithelial cells that are coated with bacteria.

Lab investigations of becterial vaginosis : 

Lab investigations of becterial vaginosis Two positive results in addition to the discharge itself are enough to diagnose BV. If there is no discharge, then all three criteria are needed. A 1990 study demonstrated that the single best test for BV was the test for clue cells on wet mount examination. The best combination of two tests for BV was the test for clue cells and the whiff test. Differential diagnosis for bacterial vaginosis includes the following: Normal discharge. Candidiasis (thrush, or a yeast infection). Trichomoniasis, an infection caused by Trichomonas vaginalis.

Bacterial Vaginosis : 

Bacterial Vaginosis

Nugent criteria for BV : 

Nugent criteria for BV In this scale, a score of 0-10 is generated from combining three other scores. This method is time consuming and requires trained staff, but it has high interobserver reliability. The scores are as follows 0–3 is considered negative for BV 4–6 is considered intermediate 7+ is considered Indicative of BV. At least 10–20 high power (1000× oil immersion) fields are counted and an average determined.

Nugent criteria : 

Nugent criteria

Noraml Gram’s Stain : 

Noraml Gram’s Stain

Culture for high vaginal swabs : 

Culture for high vaginal swabs When STD is suspected Culture is performed when patient is pregnant. To rule out the repeated vaginal infections When bacterial, candidial vaginitis is suspected

Possiable pathogens : 

Possiable pathogens Gardnerella Vaginalis G . Vaginalis with anaerobes Trichomonas vaginalis Candida species Chlamydia spp Streptococcus (A,B) E. coli

Slide 22: 

Summary

Bacterial vaginosis in pregnancy : 

Bacterial vaginosis in pregnancy Associated with adverse pregnancy outcomes to include preterm birth, preterm labor and postpartum endometritis. Neonatal sepsis All symptomatic pregnant women should be evaluated and treated.

Candida Vaginitis : 

Candida Vaginitis Produced by a ubiquitous airborne gram-positive fungus >75% of cases are caused by Candida Albicans 5-20% are produced by C. glabrata and C. tropicalis. The percentage of infections from these two organisms have increased in the past few years. Candida species are part of the normal flora of 25% of women. Prevalence greater in the rectal and oral mucosa. When the ecosystem of the vagina is disturbed, candida becomes an opportunistic pathogen. Lactobacilli inhibit the growth of fungi in the vagina; however, when the relative concentration of lactobacilli declines, the rapid overgrowth of Candida occurs.

Candida Vaginitis : 

Candida Vaginitis Primarily a disease of child bearing years. Approximately 3 out of four women will have a least one infection during their lifetime Rarely found mixed with Trichomonas or bacterial vaginosis. Not associated with other sexually transmitted diseases. No direct relationship to the number of organisms and patient signs/symptoms

Causes of Candida Vaginitis : 

Causes of Candida Vaginitis C. albicans is not usually a pathogenic organism. Overgrowth in vagina is caused by host factors that establish growth Hormonal factors: changes associated with both pregnancy and menses. ? High estrogen levels Depressed cell immunity: exogenous corticosteriods, AIDS etc Antibiotic use: broad spectrum that destroy lactobacilli

Slide 27: 

Candidal Vaginitis Commonly referred to as a yeast infection, Candidiasis is a fungal infection that usually causes a watery, white, cottage cheese-like vaginal discharges. The discharge is irritating to the vagina and the surrounding skin.Hyphal forms or budding yeast cells on microscopic evaluation pH level <4.5

Slide 28: 

Trichomonas Vaginalis Unicellular flagellated protozoan that inhabits the vagina and lower urinary tract. Estimated 2.5 to 3 million cases in the U.S. each year. Most common non-viral and non-chlamydial sexually transmitted disease. Incubation period 4-28 days and can survive up to 24hrs on wet surface.

Slide 29: 

can cause a profuse discharge with a fish-like odor, pain upon urination, painful intercourse, and inflammation of the external genitals.

Chlamydia : 

Chlamydia is a common sexually transmitted infection (STI) in humans caused by the bacterium Chlamydia trachomatis Chlamydia is a major infectious cause of human genital and eye disease. Chlamydia infection is one of the most common sexually transmitted infections worldwide C. trachomatis is naturally found living only inside human cells. Chlamydia can be transmitted during vaginal, anal, or oral sex, and can be passed from an infected mother to her baby during vaginal childbirth. Between half and three-quarters of all women who have a chlamydia infection of the neck of the cervix have no symptoms and do not know that they are infected

Chlamydia : 

Chlamydia

Lab diagnosis of Chlamydia : 

Lab diagnosis of Chlamydia The diagnosis of genital chlamydial infections evolved rapidly from the 1990s through 2006. Nucleic acid amplification tests (NAAT), such as polymerase chain reaction (PCR), transcription mediated amplification (TMA), and the DNA strand displacement amplification (SDA) now are the mainstays. NAAT for chlamydia may be performed on swab specimens collected from the cervix (women) or urethra (men), on self-collected vaginal swabs, or on voided urine. Urine and self-collected swab testing facilitates the performance of screening tests in settings where genital examination is impractical. At present, the NAATs have regulatory approval only for testing urogenital specimens, although rapidly evolving research indicates that they may give reliable results on rectal specimens.

Chlamydia : 

Chlamydia Because of improved test accuracy, ease of specimen management, convenience in specimen management, and ease of screening sexually active men and women, the NAATs have largely replaced culture, the historic gold standard for chlamydia diagnosis, and the non-amplified probe tests. The latter test is relatively insensitive, successfully detecting only 60-80% of infections in asymptomatic women, and often giving falsely positive results. Culture remains useful in selected circumstances and is currently the only assay approved for testing non-genital specimens.

Chlamydia : 

Chlamydia Chlamydia can cause Genital Disease (Vaginitis, cervicitis, urethritis) PID Conjunctivitis Reactive arthritis Prenatal infections (preterm birth, Conjunctivitis)

Summary : 

Summary

Slide 36: 

HVS Statistics of 2010

Thanks for your attention : 

Thanks for your attention

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