APIMC243889242 - CME/CMLE - Wet Preparation Overview-APIMC243889242

APIMC243889242 - Educational Activity

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This educational commentary by Dr. Sheila Criswell provides an overview of vaginal wet preparation, a rapid and inexpensive diagnostic method for vaginal infections, commonly used despite advances in molecular testing. Vaginal infections include sexually transmitted infections (STIs) like bacterial vaginitis caused by Neisseria gonorrhoeae and Chlamydia trachomatis, and less commonly, Trichomonas vaginalis. Non-STI infections are often fungal, primarily Candida species.<br /><br />Clinical symptoms prompting wet prep testing include itching, unusual odor or discharge, pain, swelling, and burning. The specimen is collected using a sterile dry cotton swab during pelvic exam, which is rotated to scrape vaginal walls and ectocervix. The swab must be tested within 15 minutes and can be prepared by placing it into saline on a microscope slide or in a saline tube, allowing multiple preparations and short storage.<br /><br />Microscopic examination begins at 10x magnification to assess cellularity and proceeds to 40x for detailed examination of at least 15–20 fields. The normal flora includes squamous epithelial cells and lactobacilli, which maintain low vaginal pH. White blood cells (neutrophils) may accompany infection. Presence of "clue cells," epithelial cells covered in bacteria, suggests bacterial vaginitis linked to STIs.<br /><br />Fungal infections show yeast forms with buds or filamentous hyphae visible at 40x magnification; misidentification with fibers from swabs or hygiene products can occur if only 10x magnification is used. Trichomonas vaginalis appear lemon-shaped with flagella and exhibit characteristic motility if examined promptly.<br /><br />Multiple concurrent infections can occur, so thorough examination is necessary. Reports typically note white blood cells and fungi semiquantitatively and presence of clue cells or Trichomonas.<br /><br />In conclusion, vaginal wet prep remains a valuable diagnostic tool for T. vaginalis and Candida infections, and can guide initial treatment for bacterial vaginitis pending confirmatory culture or PCR results.

Keywords

vaginal wet preparation

vaginal infections

sexually transmitted infections

bacterial vaginitis

Neisseria gonorrhoeae

Chlamydia trachomatis

Trichomonas vaginalis

Candida species

microscopic examination

diagnostic method