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A high vaginal swab (HVS) is a medical procedure performed in obstetrics and gynaecology to test vaginal discharge for the presence of vaginal thrush, bacterial vaginosis and trichomonas vaginalis. [1] [2] [3] It is carried out in clean conditions, by a healthcare professional who uses a speculum to look at the cervix and vagina.
Trichomoniasis (trich) is an infectious disease caused by the parasite Trichomonas vaginalis. [2] About 70% of affected people do not have symptoms when infected. [2] When symptoms occur, they typically begin 5 to 28 days after exposure. [1]
Trichomonas vaginalis from a vaginal swab. This is a heavy infection; there were probably thousands of trichomonads in the vagina. Alfred Francois Donné (1801–1878) was the first to describe a procedure to diagnose trichomoniasis through "the microscopic observation of motile protozoa in vaginal or cervical secretions" in 1836.
Viral replication is cytoplasmic. Entry into the host cell is achieved by attachment to host receptors, which mediates endocytosis. Replication follows the double-stranded RNA virus replication model. Double-stranded RNA virus transcription is the method of transcription. Protozoan parasite trichomonas vaginalis serve as the natural host. [1]
Trichomonas vaginalis, being the species that causes the most complications in humans, is the only fully sequenced Trichomonas species. Through whole-genome shotgun sequencing, the Trichomonas vaginalis genome is estimated to be around 160 Mb long, divided into six chromosomes. However, at least 65% of its genome was found to be redundant.
Trichomonas is diagnosed by looking at a sample of discharge under the microscope showing trichomonads moving on the slide. [28] However, in women with trichomonas the organism is typically detected in only 60-80% of cases. [28] Other testing, including a culture of the discharge or a PCR assay, are more likely to detect the organism. [28]
Bacterial vaginosis is usually confirmed by a Gram stain of vaginal secretions. [40] A characteristic "fishy" odor on wet mount. This test, called the whiff test, is performed by adding a small amount of potassium hydroxide to a microscope slide containing the vaginal discharge.
Another way to diagnose BV that is less often used in a clinical setting is a Nugent score. To obtain a Nugent score, gram stain techniques are carried out and it characterizes the bacterial morphology on a scale. A score greater than 7 is associated with BV, 4-6 is an intermediate abnormality, and 0-3 is normal. [42]