Effect of Short Training on Vaginal Fluid Microscopy (Wet Mount) Learning

Donders, Gilbert; Marconi, Camila; Bellen, Gert; Donders, Francesca; Michiels, Thirsa

doi:10.1097/lgt.0000000000000052

Cited by 18 publications

(6 citation statements)

References 10 publications

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“…However, as the data were retrieved from a phase 1 safety trial in breast cancer patients, higher numbers were not feasible in this setting. Also as a compensation for the small numbers, microscopic studies were done in great detail (according to the Femicare protocol [ 18 ]), allowing minimal changes to be detected more readily. Furthermore, the findings were so dramatic and universal that even in low numbers they were clear and outstanding.…”

Section: Discussionmentioning

confidence: 99%

“…Microscopy was done in a systematic way after re-hydration with a droplet of saline by using a Leica phase contrast microscope at 400 times magnification (DC 1000, Warburg, Germany) according to the classification system published elsewhere [ 18 ]. In brief, lactobacillary grades (LBG) were classified and bacterial vaginosis (BV) flora was diagnosed on the basis of the typical granular microflora.…”

Section: Methodsmentioning

confidence: 99%

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Effect of ultra-low-dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors

Donders

Bellen²,

Neven

et al. 2015

Eur J Clin Microbiol Infect Dis

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This study was a detailed microscopic analysis of the changes of vaginal microflora characteristics after application of 0.03 mg estriol-lactobacilli combination on the vaginal ecosystem in postmenopausal breast cancer (BC) survivors on aromatase inhibitors (AI) with severe atrophic vaginitis. A total of 16 BC women on AI applied daily one vaginal tablet of Gynoflor® for 28 days followed by a maintenance therapy of three tablets weekly for 8 weeks. During four follow up visits a smear from the upper lateral vaginal wall was analysed by phase contrast microscopy at 400 times magnification in order to classify the lactobacillary grades(LBG), bacterial vaginosis (BV), aerobic vaginitis (AV), vulvovaginal candidosis (VVC), proportional number of leukocytes and evidence of parabasal cells and epitheliolysis. LBG improved from 81 % LBG-III at entry to 88 % LBG-I&IIa after 2 weeks of initial therapy, which further improved upon follow up (p < 0.001). Whereas BV was a rare event, AV was frequent and substantially improved during treatment (p < 0.01). While at entry most patients had moderate or severe AV, after maintenance therapy no patient except one had AV. The number of leukocytes dropped dramatically from a score of 1.78 ± 0.70 to 1.06 ± 0.25 which was consistent till the end of the study (p < 0.01). Parabasal cells dropped from a score of 3.4 ± 0.64 at entry to 1.3 ± 0.60 at the final visit (ptrend < 0.01). Starting from a low rate of Candida colonisation of 2/14 (14 %), a sudden rise to 7/16 (44 %) occurred after 2 weeks, to return back to base levels at susequent visits. The vaginal use of ultra-low dose estriol and lactobacilli results in rapid and enduring improvement of all markers of the vaginal microflora and epithelial vaginal cell quality in women with breast cancer on AI with dyspareunia. Candida may develop soon after its use, but rapidly disappears again upon their prolonged use. Due to its excellent safety profiles and clinical efficacy we recommend this product as first choice in women on AI with severe dyspareunia.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effect of ultra-low-dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors

Donders

Bellen²,

Neven

et al. 2015

Eur J Clin Microbiol Infect Dis

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“…Differentiating between cervical mucus inflammation and the proportional number of free leukocytes per epithelial cell would have been a much more accurate way. 3 A typical feature of full blown bacterial vaginosis is the paradoxal absence of inflammation, despite heavy bacterial overgrowth. This is demonstrated by a deficient production of interleukin 1-b, lack of interleukin 8 and, as a consequence, a striking absence of inflammatory cells in the vaginal fluid of women with BV.…”

Section: Dear Dr Bedrossianmentioning

confidence: 99%

Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV‐positive women

Donders

Vieira‐Baptista

2016

Diagnostic Cytopathology

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“…Wet-mount microscopy can easily distinguish these conditions, but microscopy combined with adequate scoring systems remains largely underused in clinical practice [9]. Such a microscopic approach is easily mastered with an intense short course of training and a relatively simple phase-contrast microscope with ×400 magnification is sufficient for the analysis [17]. However, when this approach is not applied, women with serious symptoms and/or health risks could be left without proper treatment.…”

Section: Introductionmentioning

confidence: 99%

The Dwindling Microbiota of Aerobic Vaginitis, an Inflammatory State Enriched in Pathobionts with Limited TLR Stimulation

Oerlemans

Wuyts

Bellen³

et al. 2020

Diagnostics

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While bacterial vaginosis (BV) is a well-known type of vaginal dysbiosis, aerobic vaginitis (AV) is an inflammatory condition that remains understudied and under-recognised. It predisposes women to serious complications including urogenital infections and pregnancy problems. Here, we investigated the bacterial community in AV to explore its possible role in AV pathogenesis. We collected vaginal lavage fluid samples of women (n = 58) classified by wet-mount microscopy as suffering from AV or BV and included an asymptomatic reference group without signs of AV or BV. AV samples showed reduced absolute abundances of bacteria in general and specifically of lactobacilli by qPCR, but 16S rRNA gene sequencing and amplicon sequence variant analysis revealed that Lactobacillus remained the dominant taxon in 25% of the AV samples studied. The other AV samples showed high relative abundances of Streptococcus agalactiae and, unexpectedly, the anaerobes Gardnerella vaginalis and Prevotella bivia in more than half of the AV samples studied. Yet, despite increased relative abundance of these potential pathogens or pathobionts in the AV bacterial communities, the AV samples only slightly stimulated Toll-like receptor 4 and showed reduced activation of Toll-like receptor 2/6, receptors of two pathways central to mucosal immunity. Our findings indicate that the reduced total bacterial abundance with associated enrichment in certain pathobionts in AV might be mainly a consequence of the inflammatory conditions and/or altered hormonal regulation rather than bacteria being a major cause of the inflammation.

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Effect of Short Training on Vaginal Fluid Microscopy (Wet Mount) Learning

Abstract: Although further improvement is still possible, a short training course of 10 hours enables vast improvement on wet mount microscopy accuracy and results in fair to good concordance of the most important variables of the vaginal flora compared to a reference reader.

Cited by 18 publications

References 10 publications

Effect of ultra-low-dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors

Effect of ultra-low-dose estriol and lactobacilli vaginal tablets (Gynoflor®) on inflammatory and infectious markers of the vaginal ecosystem in postmenopausal women with breast cancer on aromatase inhibitors

Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV‐positive women

The Dwindling Microbiota of Aerobic Vaginitis, an Inflammatory State Enriched in Pathobionts with Limited TLR Stimulation

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