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Inflammation / parasites
Reviewer: Farnaz Hasteh, M.D., UCSD Medical Center (see Reviewers page)
Revised: 5 December 2013, last major update October 2010
Copyright: (c) 2006-2013, PathologyOutlines.com, Inc.
Definition / General
● Common cause of vaginal discharge in young women, usually due to multiple microbes
● Also called "shift in flora", Gardnerella vaginalis, "clue cells"
● Most common cause of abnormal discharge in young women
● Common finding in women with SIL (HPV infection)
● Uncommon in postmenopausal women, except those with hormonal replacement therapy
● Risk factors include multiple sexual partners, IUD, prior pregnancy, medication, spermicides and smoking
● Gardnerella vaginalis in the most common cause (eMedicine)
● Usually it is multimicrobial (Gardnerella vaginalis, Prevotella, Mobiluncus, peptostreptococci, Mycoplasma hominis and Ureaplasma urealyticum)
● Increases in vaginal pH (>4.5) can cause Gardnerella vaginalis to adhere more to squamous cells, causing the morphologic appearance of "clue cells"
● Discharge with ‘fishy” or ammonia-like odor in some patients
● Most patients are asymptomatic
● Pap smear is 80% sensitive and 87% specific; presence of “clue cells” is more sensitive and specific (Acta Cytol 2005;49:634)
● Complications are rare, and include PID, infertility, postoperative infection, premature labor or low-birth weight babies
● Clue cells are squamous cells covered by coccobacilli with extension to the cell edges (velvety coat or shaggy appearance)
● The entire cell does not need to be covered
● Lactobacilli and inflammatory cells are absent, unless there is another infectious process
● The small coccobacilli form a granular blue background (sandy background) on conventional smears
● In liquid based cytology, the background is cleaner than with conventional smears
Liquid based smears
Cervix-cytology > Inflammation / parasites > Bacterial vaginosis
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