![]() Cervical inflammation or mucopus suggest cervicitis, but cervical infections such as N. On pelvic examination, careful attention should be paid to the presence or absence of cervical inflammation, usually manifest as edema or friability, and to the presence or absence of cervical mucopus, that is, mucoprurulent secretions in the endocervical canal. In many patients, more than one cause is present.Ī careful history and physical may help to separate these two conditions and point to an etiology. The discharge may be caused by infections of the vagina itself, but infections or inflammation of the cervix also lead to an increase in vaginal discharge. Pathologic vaginal discharges are caused by a variety of infectious and noninfectious causes. These are less expensive and results are available sooner. Recently immunofluorescence techniques have become available. Chlamydia cultures are expensive and require a week for results. Ideally, this should be plated on a specific medium immediately, as delay decreases the yield sharply. gonorrhea are done by placing a sterile swab into the endocervical canal. Trichomonas may be cultured, but this is not available in most laboratories. Yeast will grow on routine culture as well as on specific media. Nevertheless, cervical cultures may be especially helpful in some cases. Depending on the results of a vaginal culture without microscopic examination of the secretions will result in frequent errors in treatment. Endocervical and ectocervical Pap smears should be obtained as described in Chapter 179.Ĭultures should never substitute for a careful history, physical examination, and microscopic examination of the wet prep. Certain cytologic changes may suggest chlamydial cervicitis. For example, trichomonas or yeast may be seen. ![]() In addition to information about cervical cytology, the Papanicolaou (Pap) smear will often add information regarding possible vaginal and cervical pathogens. An excess of leukocytes (more than 10/hpf) in the endocervical mucous suggests chlamydial cervicitis, and appropriate studies should be obtained. This is a relatively insensitive test, however, and should not substitute for a culture. If gram-negative diplococci are seen inside cells, this is diagnostic for Neisseria gonorrhea. Gram stain of the endocervical mucous may be helpful in the evaluation of cervicitis. Yeast will be detectable, and the predominant bacterial flora may be assessed (e.g., normal gram-positive bacilli or abnormal gram-negative coccobacilli and rods). Gram stain of the vaginal discharge can be done using standard methods. A positive test is abnormal and consists of a characteristic fishy odor. A drop of KOH is mixed with some vaginal discharge. The whiff test is a test for the fishy odor that occurs in bacterial vaginosis (previously called Gardnerella vaginitis and nonspecific vaginitis). ![]() The paper should include a range of pH from 4.0 to above 5.0. The pH of the vaginal secretions can be obtained by placing a sample from the lateral wall of the vagina on pH paper. The slide should then be examined carefully for the presence of budding yeast or hyphae. This aids in lysis of the cells, but leaves fungi. Heat the slide just until bubbles form under the cover slip, but no longer. Add a drop of 10% potassium hydroxide (KOH) and cover with a cover slip. A few may be normal, but more than 10 per high-power field is abnormal.Īn additional swab should be taken and some discharge placed on a slide. Lastly, the presence or absence of a large number of leukocytes should be noted. Yeast may be seen as budding or hyphal forms, and may be seen best with the addition of potassium hydroxide. Clue cells are vaginal epithelial cells with adherent coccobacilli. They are best recognized by their characteristic twisting motion. Trichomonas are motile flagellated organisms about the size of a white blood cell (WBC). A careful search of several fields should be made at both medium and high power for trichomonas, clue cells, and yeast. The slide may be warmed briefly (to increase motility of trichomonas) and should be looked at promptly. The first method is preferred if the discharge is profuse, as it will dilute the secretions so that individual cells can be seen better. Place a drop of saline on a slide and add a small amount of the discharge.
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