7. Wet Preps: Common Characteristics Saline: 40X objective Vaginitis Curriculum Source : Seattle STD/HIV Prevention Training Center at the University of Washington RBCs Squamous epithelial cell PMN RBCs Sperm Artifact

8. Wet Prep: Lactobacilli and Epithelial Cells Saline: 40X objective Vaginitis Curriculum Source : Seattle STD/HIV Prevention Training Center at the University of Washington Lactobacilli Lactobacilli Artifact NOT a clue cell

9. Vaginitis Differentiation Vaginitis Curriculum Pseudohyphae or spores if non- albicans species KOH wet mount Clue cells ( > 20%), no/few WBCs Few WBCs Motile flagellated protozoa, many WBCs Lacto-bacilli NaCl wet mount Positive Negative Often positive Negative KOH “whiff” test > 4.5 Usually < 4.5 > 4.5 3.8 - 4.2 Vaginal pH Inflammation and erythema Cervical petechiae “strawberry cervix” Clinical findings Homogenous, adherent, thin, milky white; malodorous “foul fishy” Thick, clumpy, white “cottage cheese” Frothy, gray or yellow-green; malodorous Clear to white Vaginal discharge Odor, discharge, itch Itch, discomfort, dysuria, thick discharge Itch, discharge, 50% asymptomatic Symptom presentation Bacterial Vaginosis Candidiasis Trichomoniasis Normal

10. Vaginitis Trichomonas vaginalis Trichomoniasis Curriculum

13. Lesson I: Epidemiology: Disease in the U.S. Trichomoniasis Curriculum

15. Trichomoniasis and other vaginal infections — Initial visits to physicians’ offices: United States, 1966–2003 SOURCE: National Disease and Therapeutic Index (IMS Health) Trichomoniasis Curriculum Epidemiology

18. Lesson II: Pathogenesis Trichomoniasis Curriculum

20. Trichomonas vaginalis Source : CDC, National Center for Infectious Diseases, Division of Parasitic Diseases Trichomoniasis Curriculum Pathogenesis

21. Lesson III: Clinical Manifestations Trichomoniasis Curriculum

23. “ Strawberry cervix” due to T. vaginalis Source : Claire E. Stevens/Seattle STD/HIV Prevention Training Center at the University of Washington Trichomoniasis Curriculum Clinical Manifestations

25. Lesson IV: Diagnosis Trichomoniasis Curriculum

28. Wet Prep: Trichomoniasis Saline: 40X objective *Trichomonas shown for size reference only: must be motile for identification Source : Seattle STD/HIV Prevention Training Center at the University of Washington Trichomoniasis Curriculum Diagnosis PMN Trichomonas* Squamous epithelial cells PMN Trichomonas* Yeast buds

29. Lesson V: Patient Management Trichomoniasis Curriculum

33. Lesson VI: Prevention Trichomoniasis Curriculum

37. Vaginitis Vulvovaginal Candidiasis (VVC) Candidiasis Curriculum

40. Lesson I: Epidemiology: Disease in the U.S. Candidiasis Curriculum

43. Lesson II: Pathogenesis Candidiasis Curriculum

45. Lesson III: Clinical Manifestations Candidiasis Curriculum

47. Vulvovaginal Candidiasis Source : Health Canada, Sexual Health and STI Section, Clinical Slide Gallery Candidiasis Curriculum Clinical Manifestations

48. Lesson IV: Candidiasis Diagnosis Candidiasis Curriculum

50. PMNs and Yeast Buds Saline: 40X objective Source : Seattle STD/HIV Prevention Training Center at the University of Washington Candidiasis Curriculum Diagnosis Folded squamous epithelial cells Yeast buds PMNs

51. PMNs and Yeast Pseudohyphae Saline: 40X objective Source : Seattle STD/HIV Prevention Training Center at the University of Washington Candidiasis Curriculum Diagnosis Yeast pseudohyphae PMNs Squamous epithelial cells Yeast buds

52. Yeast Pseudohyphae 10% KOH: 10X objective Candidiasis Curriculum Diagnosis Source : Seattle STD/HIV Prevention Training Center at the University of Washington Lysed squamous epithelial cell Masses of yeast pseudohyphae

53. Lesson V: Patient Management Candidiasis Curriculum

60. Lesson VI: Prevention Candidiasis Curriculum

63. Vaginitis Bacterial Vaginosis (BV) Bacterial Vaginosis Curriculum

66. Lesson I: Epidemiology: Disease in the U.S. Bacterial Vaginosis Curriculum

71. Lesson II: Pathogenesis Bacterial Vaginosis Curriculum

74. Lesson III: Clinical Manifestations Bacterial Vaginosis Curriculum

76. Lesson VI: Diagnosis Bacterial Vaginosis Curriculum

77. Wet Prep: Bacterial Vaginosis Saline: 40X objective Source : Seattle STD/HIV Prevention Training Center at the University of Washington Bacterial Vaginosis Curriculum Diagnosis NOT a clue cell Clue cells NOT a clue cell

80. Lesson V: Patient Management Bacterial Vaginosis Curriculum

85. Lesson VI: Prevention Bacterial Vaginosis Curriculum

88. Case Study