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Vaginitis: Candida, BV, Trichomoniasis – Wet Mount Whiff Test Vaginal pH Trich Albicans gardnerella

August 16, 2019

Distinguished future physicians welcome to
Stomp on Step 1 the only free videos series that helps you study more efficiently by focusing
on the highest yield material. I’m Brian McDaniel and I will be your guide on this
journey through vulvovaginal infections. This is the 3rd video in my playlist covering all
of microbio. Vulvovaginitis (AKA Vaginitis) is inflammation
of the lower genital tract. It is usually due to infection, but there are a wide variety
of causes. During this video we will focus on the 3 most important causes of vulvovaginitis
for the medical board exam (trichomonas, candida and BV). However, you should know that other
types 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 in
post-menopausal women and we will cover that in a later video in the GYN section. Gonorrhea
and Chlamydia present primarily with cervicitis, but it can also cause vulvovaginitis. G/C
will be covered later in its own video. We will start with a few different tests that
we will use to differentiate between the different infections.
Wet Prep (AKA Wet Mount Test) is a microscopic examination of vaginal discharge used to differentiate
between different types of vulvovaginitis. The vaginal specimen is obtained using a speculum
and a que tip similar to how one gets a pap smear. Then the specimen is rubbed onto a
glass slide. One half of the slide has a drop of saline added to it while the other half
of the slide has a drop of 10-20% KOH (Potassium hydroxide) added to it.
When Saline is added it makes it easier to view clue cells for BV & flagellated motile
cells for trichomonas. The KOH kills bacteria and vaginal cells leaving
only yeast cells. This makes it easier to view the psuedohyphae and budding yeast present
during vulvovaginal candidiasis. KOH is also alkalotic so it can be used for
a “Whiff Test.” In this scenario when the alkalotic KOH is added to a sample containing
BV it will create an amine or fishy smell. This is a similar principle behind how the
smell of BV can increase after unprotected sex since semen is alkalotic. The normal vaginal pH for a reproductive age
woman is about 4, while the normal vaginal pH before puberty and after menopause is about
7. During puberty there is an estrogen guided increase in the growth lactobacilli flora.
These bacteria break down glycogen into lactic acid which lowers pH from about 7 to about
4. Now that you know the normal values you can apply it to diseases. Usually, Bacterial
Vaginosis & Trichomonas have alkalotic pH (>4.5 in reproductive age women) while candida
has normal pH (4.5 in reproductive age woman) Minimal itching and inflammation/erythema
is present. Few leukocytes visible on microscopy Treatment=topical Metronidazole or oral
metronidazole if that doesn’t work. Clindamycin is another option If you have been following along with my microbio
section you will know that I already have a video on Fungi & Candida. I’m not going
to go over that same material here, but I will covere some information that is specific
to vaginal candidiasis. Vulvovaginal Candidiasis (AKA Yeast Infection)
is an overgrowth of ubiquitous fungi. The most common subtype of candida infections
in the vaginal tract is Albicans, but you also see Glabrata and Tropicalis (especially
if it is resistant to treatment). Mostly happens in patients with altered flora
(immunosuppressed, antibiotic therapy, corticosteroids) of increased glycogen (diabetics, pregnant,
OCPs) Keeping the vagina moist and warm with tightfitting
clothing like a bathing suit also is a risk factor
Severe inflammation leads to bright red erythema, vulvar pruritus (severe itching), burning,
dysuria (painful urination) & dyspareunia (painful intercourse)
Lumpy/Thick adherent white cottage cheese like discharge
Odorless Normal pH
You can see here an example of the Budding yeast & psuedohyphae seen on the KOH portion
of a wet prep Treatment=OTC topical miconazole (monostat),
oral fluconazole (diflucan) & or topical terconazole (Terazol) Trichomoniasis (AKA Trichomonas Vaginalis)
is a very contagious STD, therefore the question stem will almost always mention unprotected
sexual activity. Inflammation leads to burning, itching, erythema,
dysuria and dyspareunia. Many leukocytes are seen on microscopic examination
Patchy Erythema on cervix is referred to as Strawberry Petechiae. Note that this finding
can be easily confused with Cervicitis (Gon/Chlyamdia). Thin/watery frothy (bubbly) yellow-green discharge
On Saline prep you see motile or moving flagellated protozoa.
Can have malodorous/fishy smell/foul smell Alkalotic pH (>4.5 in reproductive age)
Treatment is oral metronidazole for both partners to prevent reinfection. So it is the same
treatment as BV which makes things a bit easier to remember. To review here are some buzzwords that should
stand out to you in question stems. If you just know the info on this slide you can probably
get most of these questions right. Trich is the only 1 of the 3 that is an STD
and motile under a microscope. A strawberry cervix is also only present in Trich when
talking about these 3 different diseases although other diseases can cause cervical inflammation.
Candida has budding yeast & psuedohyphae as well as a normal pH. BV has clue cells and
minimal itching. Thank you to CLARK JOHNSEN from New York who
generous donation helped bring this video to you all.
If you would like to help out you can donate on our website or help spread the word via
telling your classmates or even posting on social media sites like facebook. That would
really help us out. If you would like to be taken to our next
video in the microbio section you can click on this black box here. That video will be
about Viruses.


  • Reply bogacola1 January 24, 2016 at 3:21 pm


  • Reply soupper soulger March 20, 2016 at 4:31 am

    In Canada, we pronounce Candida…….Can-dee-da.

  • Reply experience March 9, 2017 at 12:52 am

    what the hell is BV

  • Reply LEANNA WESCOTT March 23, 2017 at 4:20 pm

    Worse than having a yeast infection is to cure it, to only have it come back a few days later. You might want to avoid this by using a method that also takes care of this issue such as the one you can find on Renatta Kirmzel's website.

  • Reply Marmarees ris April 10, 2017 at 12:40 am

    Thanks for the lecture 🙂

  • Reply Thor Thunder January 14, 2018 at 2:14 am

    What is a 2.5 inch long string like with what looks like a head on it which is about 1/16 wide that tapers into a string like white looking worm looking thing with a center which looks like blood in the white clear looking worm that comes out in the urine? Is this a parasite or what?

  • Reply wfleurin February 24, 2018 at 3:26 pm

    Good review

  • Reply Pari Maharjan June 16, 2018 at 1:10 am

    What is Womezon Remedy? I have noticed several amazing things about this bacterial vaginosis secret remedy.

  • Reply Jas sth July 3, 2018 at 2:58 am

    What is Womezon Remedy and how does it work? I hear many individuals cure their bacterial vaginosis issue naturally with this bacterial vaginosis secret remedy.

  • Reply Naim July 3, 2018 at 2:34 pm

    As specialist, I believe Womezon Remedy can be good way to fix your bacterial vaginosis issue naturally . Why not give it a shot? perhaps it can work for you too.

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