For vaginitis may be acute, subacute, indolent, chronic, latent and asymptomatic. The diagnosis of obesity is based on history, patient complaints, clinical picture and examination results. Carefully collected history allows to identify the nature of the discharge. Along with the evaluation of the external appearance, use litmus paper to determine the pH. If it is impossible to conduct a bacteriological and bacterioscopic investigation of the pH of vaginal discharge can play a positive role. So, if the pH is below 4.5, it is possible to think about candidal lesions. At pH higher than 4.5 can be suspected trichomoniasis.
The investigation of the patient’s vaginal mirrors can detect typical signs of inflammation or atrophic changes of the vaginal epithelium. However, especially more information can be obtained when microscopic examination native smear, bacteriological examination of secretions with seeding of vaginal contents in the nutrient medium, as well as conducting a number of modern methods of examination of patients.
Bacteriological and bacterioscopic study helps to clarify specific or nonspecific vaginitis. When sowing on a nutrient medium to determine the sensitivity of microflora to antibiotics. Direct microscopy of unstained native of drugs used for the diagnosis of trichomoniasis, bacterial vaginitis and candidiasis in the presence of a vaginal discharge.
To obtain a sample for research, it is necessary to take it from the back arch a thin cotton swab. The obtained sample is then immediately placed on a glass slide and quickly diluted with a drop of isotonic solution of sodium chloride, then applied to the glass coverslip, which was tentatively applied to the material. The obtained product is immediately placed on the microscope stage and examined under low magnification (X40) in low light.
Trichomoniasis in the product are clearly expressed specific pattern with diagnostic value. Trichomonads have a characteristic discontinuous and jerky movements, the native product look like transparent organisms pear shaped, equal in size to the leukocyte. They have four anterior flagella and axostyle that permeates in the form of a rod the whole body of the parasite. Trichomonas is in native product soon lose their characteristic jerky movements and their undulipodia membrane become visible, especially at high magnification. For bacterial vaginitis is characterized by replacement of vaginal flora lactobacillary other specific groups of bacteria and the change of properties of the vaginal fluid. The typical fish smell of the liquid is enhanced by the addition to the sample of vaginal secretions 2 drops of 10% solution of potassium hydroxide. This so-called “olfactory” test.
The white cell count is within normal limits or slightly elevated. The number of epithelial cells in one visual field under the microscope more than the number of white blood cells. Trichomoniasis is defined by a larger number of cells. In bacterial vaginitis to reveal the “key” cells, which are cells keratinized, squamous epithelium, covered with coccobacilli. As a result, the surface becomes indistinct, and the cytoplasm granules are visible. In native microscopic preparations it is possible to clearly detect yeast. Diagnosis facilitates the addition of a 10% solution Saone, which leads to the destruction of clusters of epithelial cells, after which a microscopic picture becomes more clear.
In addition to microscopy of nativesupport algorithm microscopy study of vaginal direct microscopy of stained preparations. For making smears the obtained sample is then quickly transferred to a glass slide where the material is distributed in a thin layer with a swab or loop , smear air-dried, then fixed three times quickly swiping through the upper part of the burner flame. Avoid excessive heat stroke. The color of the stroke carried out by the gram stain, methylene blue or safranin. However, the gram stain has the advantage, as it allows to identify the diplococci.
If you suspect gonorrhea stained preparations examined under oil immersion. Gonococci (gram-negative diplococci) are in the form of kidney or coffee bean, 0.6-0.8 microns. The presence of these diplococci in polymorphonuclear leukocytes is highly specific for gonorrhea sign. Against chlamydia and Mycoplasma should be borne in mind that microbiological methods for the determination of these prokaryotes are difficult, roads and are poorly reproducible. Chlamydiae form cytoplasmic inclusion bodies of Prowazeki in the epithelium of the vagina, which can be detected when the color of the drug by the Giemsa method should turn. But this method is not sufficiently sensitive and specific.
These shortcomings deprived of a method of immunofluorescence using monoclonal antibodies against the principal outer membrane protein of chlamydia. A promising method for DNA hybridization. Immunoassay method gives cross reactions with E. coli, gonococci, streptococci, and other microbes. In superficial forms of chlamydia develops low humoral response with low antibody titers. As a consequence, the most sensitive and specific diagnostic method for chlamydia trachomatis – the cultivation of pathogens in cell cultures of MSO, L-929, Hela-229. To transport test material suitable medium 199, Wednesday Needle and medium with addition of antibiotics to which resistant chlamydia (penicillin, streptomycin, gentamicin). Samples store no more than days at plus 4єС and up to 2 weeks at minus 70єС. The answer is not earlier than 72 hours from the start of the study. The staff undergoes a high risk of infection.