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Difficulty: EasyGynecologic Infections

Review the following microscopic descriptions of vaginal secretions prepared with normal saline or potassium hydroxide. Associate each distinct microscopic finding with the most likely corresponding gynecologic infection.

  • Epithelial cells with indistinct margins covered by tiny coccobacilliBacterial Vaginosis
  • Pear-shaped, flagellated organisms exhibiting twitching motilityTrichomoniasis
  • Branching filamentous structures and budding yeast cellsVulvovaginal Candidiasis

Answer

Epithelial cells with coccobacilli match Bacterial Vaginosis; flagellated organisms match Trichomoniasis; branching filamentous structures match Vulvovaginal Candidiasis.
Each type of vaginitis has a highly distinct, classic microscopic appearance on diagnostic wet mount or KOH preparation. Bacterial vaginosis is uniquely characterized by clue cells, trichomoniasis by actively motile trichomonads, and candidiasis by the presence of pseudohyphae and budding yeast.

Step-by-Step Solution

1
Analyze the first microscopic description (indistinct margins covered by tiny coccobacilli).
Identify this description as a 'clue cell'.
Clue cells are vaginal epithelial cells stippled with adhering anaerobic bacteria, which is the pathognomonic microscopic finding for Bacterial Vaginosis.
2
Analyze the second microscopic description (pear-shaped, flagellated organisms with twitching motility).
Identify this as the protozoan Trichomonas vaginalis.
Trichomonads are unique among common vaginal pathogens in their motility and flagellated structure, confirming a diagnosis of Trichomoniasis.
3
Analyze the third microscopic description (branching filamentous structures and budding yeast cells).
Identify this as pseudohyphae and spores.
These fungal elements are characteristically seen in Vulvovaginal Candidiasis, often enhanced by adding 10% potassium hydroxide (KOH) to the slide.

Key Concept

Microscopic diagnosis of common vaginitis etiologies
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Topics

Gynecologic Infections

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