What is the cleanliness of vaginal discharge?

What is the cleanliness of vaginal secretions? Many people have a vague concept of the cleanliness of vaginal secretions, and many people have never heard of medical terms that are not often encountered in life. Women need to pay attention to the cleanliness of vaginal secretions. What is the cleanliness of vaginal secretions? What role does the cleanliness of vaginal secretions play? What conclusions can be drawn from the cleanliness of vaginal secretions?

Cleanliness is expressed in Roman numerals

Epithelial cells and white blood cells are indicators of vaginal cleanliness examination. When epithelial cells are normal, they fill the field of view under a high-power microscope, while white blood cells are absent or present in small quantities.

Clinical significance of components found in cleanliness

Grade Ⅰ: A large number of vaginal bacilli and epithelial cells, 0-5 white blood cells/HPF, no or very few other bacteria, normal

Grade II: moderate amount of vaginal bacilli and epithelial cells, 10-15 white blood cells/HPF, small amount of miscellaneous bacteria is also normal

Grade III: A small amount of vaginal bacilli and epithelial cells, 15-50 white blood cells/HPF, and a large number of miscellaneous bacteria indicate inflammation

Grade IV: There are no vaginal bacilli, but a small amount of epithelial cells, white blood cell count 0-5/HPF, and a large number of miscellaneous bacteria. Most common in severe vaginitis

Note: HPF means high power field. For example, WBC 0-5/HPF means there are 0-5 white blood cells in the high power field under the microscope.

1. General characteristics examination Normal vaginal discharge is white, thin and paste-like, generally odorless. The amount is related to the level of estrogen and the congestion of the reproductive organs. Near ovulation, the amount of leucorrhea is large, clear, transparent, and thin like egg white. 2-3 days after ovulation, the leucorrhea becomes turbid and sticky, with a small amount, and the amount increases again before menstruation. The amount of leucorrhea during pregnancy is more.

Abnormal leucorrhea may manifest as changes in color, quality, and quantity:

1. Large amounts of unencapsulated transparent, sticky leucorrhea are common after the use of estrogen drugs and in ovarian granulosa cell tumors.

2. Purulent leucorrhea: yellow or yellow-green with a foul odor, mostly caused by Trichomonas or purulent bacterial infection; foamy purulent leucorrhea is common in Trichomonas vaginitis; other purulent leucorrhea are seen in chronic cervicitis, senile vaginitis, endometritis, uterine pyometra, vaginal foreign bodies, etc.

3. Tofu-like leucorrhea: It is tofu-like or curd-like small pieces, which is unique to Candida vaginitis and is often accompanied by vulvar itching

4. Bloody leucorrhea: mixed with blood, the amount of blood is uncertain, and it has a special odor. This type of leucorrhea should alert you to the possibility of malignant tumors, such as cervical cancer, uterine body cancer, etc. Sometimes blood can be seen in the leucorrhea due to side effects caused by certain cervical polyps, submucous uterine fibroids, senile vaginitis, severe chronic cervicitis and intrauterine contraceptive devices.

5. Yellow watery leucorrhea: caused by degeneration and necrosis of diseased tissue. It often occurs in submucosal uterine fibroids, cervical cancer, uterine body cancer, fallopian tube cancer, etc.

2. Cleanliness inspection

Add physiological saline to vaginal secretions to make a smear, and examine it under a high-power microscope. The cleanliness level is mainly determined by the number of white blood cells, epithelial cells, vaginal bacilli and miscellaneous bacteria, as shown above. When ovarian function is insufficient, estrogen is reduced, and vaginal epithelial hyperplasia is poor, a decrease in vaginal bacilli can be seen, making it more susceptible to infection by miscellaneous bacteria. If the cleanliness is poor and no pathogenic microorganisms are found, it is nonspecific pyelitis. When the cleanliness level is III to IV, pathogenic microorganisms can often be found at the same time, indicating the presence of vaginitis caused by infection.

Microbiological examination

(A) Protozoa The main protozoa that cause vaginal infection are Trichomonas vaginalis, which can cause Trichomonas vaginitis. The patient has burning pain and itching in the vulva, and the vaginal discharge is purulent or foamy. When the discharge is observed under a low-power microscope using the saline hanging drop method, the worm body can be seen moving in a wavy or spiral shape, pushing the surrounding white blood cells or epithelial cells. Under a high-power microscope, the body of the worm is 8-45 um in size, with a wide neck and an inverted pear-shaped tail. It is 2-3 times the size of a white blood cell. There are four anterior flagella at the neck end of the worm body and one posterior flagellum at the rear end. There are motor membranes on the sides of the body for movement. At this time, the cleanliness of vaginal secretions is level III or IV. The suitable temperature for the growth and reproduction of Trichomonas vaginalis is 25-42 degrees Celsius, so attention should be paid to keeping warm during the inspection so that the activity of Trichomonas vaginalis can be observed. The detection of Trichomonas in vaginal secretions is the basis for the diagnosis of Trichomonas vaginitis. When amebic trophozoites are seen in vaginal secretions, it indicates amebic vaginitis.

(ii) Fungal vaginal fungi sometimes exist in the vagina without causing any harm, but they are more likely to develop when the vagina's resistance is reduced. The diagnosis of fungal vaginitis is based on the presence of fungi. Vaginal fungi are mostly white Candida, with occasional vaginal cilia and actinomycetes.

(III) Neisseria gonorrhoeae Gonorrhea is one of the most common sexually transmitted diseases in the world. Domestic statistics show that they account for about 40% of outpatient STD patients. Humans are the only host for Neisseria gonorrhoeae. Under the condition of disordered sexual relations, it causes widespread infection and epidemic among the population. Clinically, most cases present with acute symptoms, while a few are chronic processes. The smear method is first used for the examination of Neisseria gonorrhoeae. The positive rate of smear of endocervical secretions is the highest, which is 100%; the upper 1/3 of the vagina is 84%; and the vaginal opening is 35%. Because Neisseria gonorrhoeae has weak resistance to various physical and chemical factors, the smear method may miss the diagnosis. Neisseria gonorrhoeae culture can be performed when necessary, which is beneficial for strain typing and drug allergy testing. For those with non-apparent gonorrhea infection, microscopic examination and culture tests of Neisseria gonorrhoeae are often negative, but they are an important source of gonorrhea infection.

(IV) Bacterial vaginosis, which is caused by Gardnerella vaginalis and certain anaerobic bacteria, is also a sexually transmitted disease. The bacteria can also be spread non-sexually. In addition to causing vaginosis, it can also cause premature birth, puerperal fever, neonatal sepsis, chorioamnionitis, sepsis and sepsis. Gardnerella vaginalis produces high concentrations of pyruvate, an amino acid that can be decarboxylated by vaginal anaerobic bacteria to produce corresponding amines, causing skin and mucous membrane allergies. Vascular permeability increases, epithelial cells fall off, and vaginal discharge is creamy and abundant with a foul odor. Gram staining of the patient's vaginal secretions may reveal vaginal or irregular staining, and sometimes may stain into Gram-positive small rods. The size is (1.5-2.5) μm × 0.5 μm, it is polymorphic, rod-shaped or bulb-shaped, the pH of vaginal secretions is usually 4.5, and the amine test is positive.

(V) Chlamydia Urogenital tract infection with Chlamydia trachomatis is one of the most common sexually transmitted diseases. The reproductive tract infection rate is reported to be 10% abroad. 8%. Since there are no specific symptoms after infection, the disease can easily become prevalent, causing acute vaginitis and cervicitis. The leucorrhea caused by genus infection is purulent and mucous, which is different from the purulent leucorrhea caused by bacterial infection. The most widely used method at present is the direct fluorescent antibody method using fluorescently labeled monoclonal antibodies, which can quickly determine which serotype of Chlamydia is sensitive.

(6) Viruses A considerable number of human sexually transmitted diseases are caused by viruses. Viruses that can be detected in vaginal discharge include:

1 Herpes simplex virus (HSV) has two serotypes, HSV-I and HSV-II. The main type of reproductive tract infection caused by the virus is type II, accounting for about 85%. It manifests as genital herpes and ulcers, and causes fetal infection through the placenta, resulting in stillbirth, miscarriage and deformity. Due to the low positive rate of vaginal secretion examination and the complex and time-consuming operation of virus culture, in recent years, the examination of HSV has mainly adopted fluorescent antibody examination or molecular biological diagnosis, especially the use of highly specific DNA fragments in the HSV genome (HSV-I and HSV-Ⅱ), thymidine kinase oligonucleotide probes and RNA probes for molecular hybridization, which can quickly and sensitively diagnose HSV infection.

2. Human cytomegalovirus is the main pathogen of congenital infection. After a single infection, the virus remains latent in the body all year round. When the body's immunity is low, the virus is activated and may manifest as cytomegalovirus inclusion disease. Invasion of the fetal central nervous system during pregnancy can lead to sequelae such as microcephaly, mental retardation, and visual and hearing impairment. Therefore, the examination of cytomegalovirus in pregnant women's vaginal secretions is particularly important for pregnancy monitoring, and cervical swabs are often used to collect secretions for testing.

3. The main manifestations of human papillomavirus are: ① Proliferative infection, that is, the virus replicates in the host cells, produces infected progeny and causes cell death. ② Cell transformation causes tumorigenesis, mainly causing squamous cell sarcoma-like changes in the reproductive tract. Patients with warty growths in the lower genital tract can often undergo pathological microscopic or electron microscopic examination, in which typical virus-infected cells or intercalary virus particles may be seen.

Although some examinations are graded and assessed, this is only the examination result of the extracted part of the tissue at this moment. The specific diagnosis still requires the doctor to make a comprehensive judgment based on other examinations. For example, in the examination of vaginal cleanliness, degree I is normal, and although degree II is also within the normal range, the doctor will judge whether there is a mild infection based on the specific circumstances during the examination. It is recommended that women have a check-up once a year starting within three years of becoming sexually active.

Routine examination of leucorrhea

Purpose of examination: Leucorrhea is a mixture of vaginal mucosal exudate, cervical canal and endometrial gland secretions, and its formation is related to the action of estrogen. It is used to check for the presence of Trichomonas and Candida in the vagina, and can also determine the cleanliness of the vagina.

The cleanliness of vaginal secretions can measure the physical health of women. The cleanliness of vaginal secretions can be divided into grades. Different grades indicate different problems. If you want to know the details, you can consult relevant professionals. Many female patients should be exposed to the indicator of vaginal secretion cleanliness during examination.