Microscope Slide Coverslips

Vaginal thrush

may spread to the thighs. Examination may be difficult because of tender ness. With heavy infection the discharge is thick and white, when it' removed the vaginal wall is seen to be red and inflamed. Not every ca shows the typical white discharge, and diagnosis must not depend 0

naked-eye appearances alone.

The fungus can be demonstrated in the clinic in wet preparation

Mycelial threads are seen (Fig. 13.1). The organism grows easily in labo tory cultures in which gram-positive mycelia and spores are seen.

Treatment

A fungicide is inserted into the vagina. Nystatin pessaries (100 000 uni are often used, being inserted for 14 successive nights. This will be roo effective if nystatin cream is also applied to the vulva and nystatin table (500000 units) are taken twice daily by mouth to combat possible infection from the bowel. Other drugs which can be used are clotrimaz vaginal tab lets (C anesten), amphotericin pessaries (Fungilin) and miconaz

nitrate pessaries (Gyno-Daktarin).

Infection with Trichomonas vaginalis

The infection is usually transmitted by a male carrier during sexual int

course, but it may also be carried on toilet articles from one woman another. Cross-infection in antenatal and gynaecological clinics may oc and disposable gloves should be used for examination.

There is usually a profuse and offensive discharge which produ irritation and soreness but in a few cases the discharge is less, and it is sufficient to rely on naked eye appearances for diagnosis. The onse

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Vaginitis and vaginal discharge III

sudden, and there may be a history of previous similar attacks. This infection can occur in women of any age, and is often seen during pregnancy.

There may be inflammation of the vulva, and vaginal examination may be difficult because of soreness. There is a profuse thin greenish-yellow discharge with a characteristic odour which contains minute bubbles of gas. The vaginal wall is intensely red and inflamed, and numerous minute punctate ulcers ('strawberry spots') may be seen.

The diagnosis is easily established in the clinic by examination of the discharge. A little of it is taken with a wire loop or pipette and placed in a drop of normal saline on a glass slide and, after application of a coverslip, examined at once with a microscope, using a 4 mrn objective. If the specimen is examined without delay there is no need to warm the saline or the slide. The Trichomonas will be recognized by its motility. Numerous leucocytes, will also be seen. The trichomonads are a little larger then leucocytes, and if stained can be shown to have flagella at one end and a spear-like protrusion at the other, with an undulating membrane at the side.

Treatment

Metronidazole (Flagyl) is given orally, 200 mg three times daily for a week. Since patients are often reinfected by their sexual partners, the male should be given the same treatment. Alternatively, 2 doses of 2 g may be given in one day, followed by 1 g daily for 7 days. If patients on metroni- dazole take alcohol they may suffer headaches and flushing. Subsequent recurrence of the infection calls for a further course of treatment and examination of the consort; the Trichomonas may be found in the urethra or under the prepuce.

Infection with Gardnerella vaginalis Doubts have been expressed about the role of this organism in vaginal infections. It is a small gram-negative rod. The diagnosis is possible when a patient complains of a smelly non-irritating greyish-white discharge, which may contain small bubbles like those of trichomonal infection. If a drop of discharge is mixed with a drop of 10 per cent solution of potassium hydroxide there is an ammoniacal odour(Amies test), but the same occurs if trichomonads or spermatozoa are present. A smear preparation may show clue cells -epithelial cells which appear stippled because of adherent bacteria. For laboratory culture some discharge should be sent in Stuart's transport medium.

The treatment is the same as that for trichomoniasis (see above).

Gonorrhoea (seep. 138)

Other causes of vaginitis and vaginal discharge Vaginitis may result from sensitivity to spermicides used for barrier contraception, or from the accidental use of some unsuitable fluid for a douche (e.g. lysol). A retained pessary or a forgotten tampon or swab will produce a most offensive purulent discharge. With cervical erosions or

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what are the coverslips used forwhen slides are made (microscopes)?

protecting the specimen and ensuring that the surface you are looking at is thin and of a uniform thickness

Making Wet Mounts