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A vaginal wet mount with a clue cell, indicating bacterial vaginosis. Bacterial vaginosis generally produces a vaginal discharge that is thin and milky with a fishy odor. [1] Diagnosis is made using Amsel Criteria - three of the four following criteria must be met: >20% of the epithelial cells are clue cells (the single most reliable predictor) [4]
The presence of clue cells on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge.
Micrograph of a clue cell (center), covered in bacteria, as compared to an unremarkable squamous cell at bottom left, and a neutrophil at bottom center. Pap stain Phase contrast microscopy of clue cells in a vaginal swab. Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria ...
The two can be distinguished using a wet-mount slide, where a swab of the vaginal epithelium is diluted and then placed onto a slide for observation under a microscope. Gardnerella reveals a classic "clue cell" under the microscope, showing bacteria adhering to the surface of squamous epithelial cells. [19]
To diagnose BV in a clinical setting, an Amsel's criteria is used. This means that a patient must have an increased homogeneous thin vaginal discharge, pH secretion higher than 4.5, amine odor when secretions are exposed to hydroxide 10% solution, or clue cells visible on a wet mount.
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Next, thrust in an inward and upward motion on the diaphragm. This will force air out of the lungs and remove the blockage. Repeat these abdominal thrusts up to five times, the doctor advised.
Vaginal discharge is not always present in yeast infections, but when occurring it is typically odorless, thick, white, and clumpy. [28] Vaginal itching is the most common symptom of candida vulvovaginitis. [28] Women may also experience burning, soreness, irritation, pain during urination, or pain during sex. [30]