Vaginal Microscopy Summary Table A

Findings associated with pH ≤ 4.5

(Highlighted areas indicate increasing abnormalities on the slide, despite the normal pH.)

MICROSCOPY FINDINGS
(Click on “cameras” for photos of slides.)		 POSSIBLE INTERPRETATIONS WHEN PATIENT SYMPTOMATIC OTHER ACTIONS
(This is the gold standard for “normal” in women with adequate estrogen, either those of reproductive age not lactating, or older women using estrogen topically or orally. Compare all other findings with these).
Box 1:
Normal squamous cells
No clue cells
No parabasal cells
1 WBC per epithelial cell
Lactobacilli present
Negative whiff
KOH negative for Candida 		1) Normal physiologic discharge; reassure patient.
2) Candida (yeast does not always show up on wet prep)
3) Normal discharge with symptoms from pelvic floor, vulvodynia, or vulvar epithelium.		 1) Yeast culture
2) Complete Algorithm steps to reach diagnosis.
3) Reevaluate if yeast culture negative and symptoms persist.
Box 2:
Normal squamous cells
No clue cells
Occasional parabasal cell

1 WBC per epithelial cell
Lactobacilli present
Negative whiff
KOH negative for Candida 

 1) Normal discharge with symptoms from pelvic floor, vulvodynia, or vulvar epithelium.
2) Candida 
3) Early inflammatory vaginitis (DIV)
4) Early/mild atrophy		 1) Yeast culture
2) Complete Algorithm steps to reach diagnosis.
3) Re-evaluate if yeast culture negative and symptoms persist.
Box 3:
Normal squamous cells
No clue cells
1 or more parabasal cells
>1 WBC per epithelial cell
Lactobacilli present, may be reduced in number

Negative whiff
KOH negative for Candida 

 1) Candida
2) Cervicitis if cervix inflamed, with or without discharge.
3) Early inflammatory vaginitis (DIV)
4) Early/mild atrophy		 1) Yeast culture
2) GC, chlamydia, herpes testing; consider Pap smear.
3) Consider mild atrophy in older or lactating women.
4) Consider early DIV.
5) Re-evaluate if tests negative and symptoms persist.
6) Complete Algorithm steps.
Box 4:
Any of the above configurations with KOH positive for pseudohyphae or budding spores. (Look through all the photos to see both Albicans and non-Albicans yeast.) 		 Candida 1) Yeast culture will speciate for type of yeast.
2) Treat appropriately.
3) Complete Algorithm steps.
Box 5:
Any of the above configurations may include globules of creams being used, dust, fibers from a Q-tip, and other types of artifact. RBC’s may be present and confuse the picture. 		 Artifact Be sure not to be misled by artifact that can look like spores or hyphae, or lactobacilli, etc.