Bacterial vaginosis Pelvic inflammatory disease

The female vagina is an open organ that is often invaded by bacteria, so more attention should be paid to the cleanliness of the private parts. Women often have discharges such as leucorrhea and menstruation from their lower body. Normal leucorrhea is milky white and is a relatively transparent substance. When women suffer from gynecological diseases, the leucorrhea discharge will also show some signs. When a woman finds that her leucorrhea has a fishy smell and an abnormal color, she should consider whether she has related diseases such as bacterial vaginosis.

examine

1. Smear microscopy

Clue cells can be found by taking a smear of the secretions. Clue cells are epithelial cells with a large number of Gardnerella attached to the surface. The characteristics are that the surface of the epithelial cells is rough or has fine particles, and the bacteria are Gram-negative coccobacilli.

2. Amine test

Take a drop of 10% potassium hydroxide solution and add it to the vaginal secretions. You can smell a "fishy" ammonia released because the secretions have a high amine content and can release ammonia gas when they come into contact with alkali.

3. Cultivation method

After isolation and then culture, round, opaque, smooth-surface colonies with a diameter of 0.5 mm can be seen.

4. Biochemical method

Vaginal secretions were taken for biochemical analysis. Normal women had high lactate levels and low succinate levels, while women with this disease had the opposite values.

5. Fluorescent Antibody Method

The smear was stained with fluorescent antibody and examined under a microscope.

diagnosis

1. Vaginal discharge is grayish white, sticky, paste-like, uniform and non-purulent.

2. The secretion has a high amine content and a fishy smell. During sexual intercourse or after activity, the release of amines is promoted, making the odor worse. Adding 10% potassium hydroxide to the secretion can release the amine smell.

3. The pH value in vaginal secretions increases to 5.0-5.5, while the normal pH value is 3.7-4.5.

4. Clue cells can be detected in smears of vaginal secretions.

Pelvic inflammatory disease refers to inflammation of the female reproductive organs, connective tissue around the uterus, and pelvic peritoneum.

1. Direct smear of secretions

The samples can be vaginal, cervical, or urethral secretions, or peritoneal fluid (obtained through the posterior fornix, abdominal wall, or laparoscopy), and direct thin-layer smears are made and stained with methylene blue or Gram's blue after drying. If Gram-negative diplococci are seen in polymorphonuclear leukocytes, it is a gonorrhea infection. Because the detection rate of endocervical gonorrhea is only 67%, a negative smear cannot exclude the presence of gonorrhea, while a positive smear is specific. Fluorescein monoclonal antibody dye can be used for microscopic examination of Chlamydia trachomatis. The test is positive if a star-shaped flashing fluorescent spot is observed under a fluorescence microscope.

2. Pathogen Culture

The specimens come from the same source as above and should be inoculated onto Thayer-Martin medium immediately or within 30 seconds and cultured in a 35°C incubator for 48 hours for bacterial identification. New relatively rapid chlamydial enzyme assays have replaced traditional chlamydial detection methods. Mammalian cell culture can also be used to detect Chlamydia trachomatis antigens. This method is an enzyme-linked immunosorbent assay.

Bacteriological culture can also obtain other aerobic and anaerobic strains and serve as a basis for selecting antibiotics.

3. Posterior fornix puncture

Posterior fornix puncture is one of the most commonly used and valuable diagnostic methods for gynecological acute abdomen. The contents of the abdominal cavity or the rectouterine fossa obtained through puncture, such as normal peritoneal fluid, blood (fresh, old, clotted blood, etc.), purulent secretions or pus, can further clarify the diagnosis. Microscopic examination and culture of the punctured material are even more necessary.

4. Ultrasound examination

It mainly involves B-type or grayscale ultrasound scanning and filming. This technology has an 85% accuracy in identifying masses or abscesses formed by adhesions of the fallopian tubes, ovaries and intestines. However, mild or moderate pelvic inflammatory disease is difficult to show characteristics on B-mode ultrasound images.

5. Laparoscopy

If it is not diffuse peritonitis and the patient's general condition is good, laparoscopy can be performed on patients with pelvic inflammatory disease or suspected pelvic inflammatory disease and other acute abdominal diseases. Laparoscopy can not only make a clear diagnosis and differential diagnosis, but also make a preliminary judgment on the severity of pelvic inflammatory disease.

6. Examination of male partners

This helps in the diagnosis of pelvic inflammatory disease in women. The urethral secretions of the male partner can be taken for direct smear staining or culture of gonococci. If the result is positive, it is strong evidence, especially in those who are asymptomatic or have mild symptoms. Or a higher number of white blood cells may be detected.

1. Minimum Standards

Cervical motion tenderness or uterine tenderness or adnexal tenderness.

2. Additional Standards

The body temperature is over 38.3℃, there is mucopurulent secretion in the cervix or vagina, a large number of white blood cells are seen in the 0.9% NaCl smear of vaginal secretions, the erythrocyte sedimentation rate is increased, and the C-reactive protein is elevated; the laboratory confirms that the cervix is ​​positive for Neisseria gonorrhoeae or Chlamydia.

3. Specific standards

Endometrial biopsy revealed histologic evidence of endometritis, transvaginal ultrasonography or magnetic resonance imaging revealed tubal wall thickening, luminal fluid, with or without concurrent pelvic effusion, or tubo-ovarian abscess, and laparoscopy revealed abnormal findings consistent with PID.

For patients with a history of acute pelvic inflammatory disease and symptoms and signs, diagnosis is usually not difficult. However, sometimes patients have many symptoms but no obvious history of pelvic inflammatory disease or positive signs. At this time, the diagnosis of chronic pelvic inflammatory disease must be made with caution to avoid making a hasty diagnosis and causing mental burden to the patient. Sometimes pelvic congestion or varicose veins within the broad ligament can also produce symptoms similar to chronic inflammation. Chronic pelvic inflammatory disease and endometriosis are sometimes difficult to distinguish. Endometriosis causes more obvious dysmenorrhea, and the feeling of typical nodules will help with diagnosis. Laparoscopy can be performed when differentiation is difficult. Hydrosalpinx or tubo-ovarian cysts need to be differentiated from ovarian cysts. In addition to a history of pelvic inflammatory disease, the former has a sausage-shaped lump with a thin cyst wall and adhesions around it; while ovarian cysts are generally more round or oval in shape, have no adhesions around them, and move freely. Pelvic inflammatory adnexal masses are adhered to the surrounding area and are immobile, which can sometimes be confused with ovarian cancer. Inflammatory masses are cystic while ovarian cancer is solid. B-mode ultrasound examination can help to differentiate them.

Acute and chronic pelvic inflammatory disease can be diagnosed based on history, symptoms, and signs. However, differential diagnosis must be done well. The main differential diagnoses of acute pelvic inflammatory disease include acute appendicitis, ectopic pregnancy, ovarian cyst pedicle torsion, etc.; the main differential diagnoses of chronic pelvic inflammatory disease include endometriosis and ovarian cancer.