Test your ability to read Gram-stained genital samples

1. Test your ability to read Gram-stained genital samples

2. What you need to do • You are about to view 10 images of Gram-stained genital samples • Each image is accompanied by a set of questions • You need to view the image and answer the questions • The answers to the questions appear on the slide immediately after the test slide

3. Slide 1 Describe the components of this image of Gram-stained vaginal flora Indicate to which Ison/Hay grade this image belongs What is the clinical significance of this appearance?

4. Answer Slide 1 • Describe the components of this image of Gram-stained vaginal flora • Multiple Gram positive cocci • Epithelial cells 2. Indicate to which Ison/Hay grade this image belongs • Grade 4 3. What is the clinical significance of this appearance? • Unknown

5. Slide 2 Describe the components of the image (this is a male urethral sample) What clinical condition is this appearance associated with?

6. Answer Slide 2 • Describe the components of the image • Polymorphs >30 per high power field • Occasional epithelial cell • No bacteria seen • What clinical condition is this appearance associated with? • Non-gonococcal urethritis

7. Slide 3 Describe the components of this image of Gram-stained vaginal flora Indicate to which Ison/Hay grade this image belongs How would you report these findings?

8. Answer Slide 3 • Describe the components of this image of Gram-stained vaginal flora • Epithelial cells • Gram positive bacilli (rods) –lactobacillus morphotypes • Gram negative bacilli (rods) 2. Indicate to which Ison/Hay grade this image belongs • Grade 1 3. How would you report these findings? • Normal lactobacillus species present and high numbers of lactobacilli that appear Gram –negative. This could be either due to decolourisation or antibiotic usage which has killed many of the lactobacilli present

9. Slide 4 Describe the components of this this image of Gram-stained vaginal flora Indicate to which Ison/Hay grade this image belongs 3. What are the symptoms classically associated with this appearance?

10. Answer Slide 4 1. Describe the components of this image of Gram-stained vaginal flora • Mixed bacterial flora predominately Gram-negative bacteria • Gram negative curved rods • No lactobacillus morphotype • Epithelial cells but no clue cells seen 2. Indicate to which Ison/Hay grade this image belongs • Grade 3 3. What are the symptoms classically associated with this appearance? A malodorous discharge (although up to 50% may be asymptomatic)

11. Slide 5 Describe the components of this image of Gram-stained vaginal flora Indicate to which Ison/Hay grade this image belongs How would you report these findings?

12. Answer Slide 5 • Describe the components of this image of Gram-stained vaginal flora • Mixed bacterial flora, both Gram positive and Gram negative bacteria • Small numbers of Gram positive bacilli (rods) –lactobacillus morphotypes • Epithelial cells with some adherent bacteria 2. Indicate to which Ison/Hay grade this image belongs • Grade 2 • How would you report this appearance? • Intermediate flora

13. Slide 6 Describe the components of the image of this Gram-stained cervical sample How would you report this appearance?

14. Answer Slide 6 • Describe the components of the image • Polymorphs • Epithelial cells • Intracellular Gram negative cocci • Extracellular Gram negative cocci • Gram positive bacilli (rods) – lactobacillus morphotype 2. How would you report this appearance? • Presumptive diagnosis of gonorrhoea

15. Slide 7 Describe the components of this image of Gram-stained vaginal flora Indicate to which Ison/Hay grade this image belongs How would you report this Gram-stained vaginal smear?

16. Answer Slide 7 • Describe the components of the image • Gram positive bacilli (rods) –lactobacillus morphotypes, of varying sizes • Occasional Gram positive cocci • Epithelial cells 2. Indicate to which Ison/Hay grade this image belongs • Grade 1 3. How would you report this Gram-stained vaginal smear? • Normal flora

17. Slide 8 Describe the components of this image of Gram-stained vaginal flora What clinical condition would fit with this appearance?

18. Answer Slide 8 • Describe the components of this image of Gram-stained vaginal flora • Gram positive bacilli (rods) –lactobacillus morphotypes • Yeast cells, some of which are budding • Hyphae • Epithelial cells • What clinical condition would fit with this appearance? • Candida sp infection

19. Slide 9 Describe the components of the image How would you report this appearance?

20. Answer Slide 9 • Describe the components of the image • Polymorphs • Occasional epithelial cell • Intracellular Gram negative cocci • Extracellular Gram negative cocci • Gram negative bacilli (rods) • How would you report this appearance? • Presumptive diagnosis of gonorrhoea

21. Slide 10 Describe the components of this image of Gram-stained vaginal flora Indicate to which Ison/Hay grade this image belongs What clinical condition is this appearance associated with?

22. Answer Slide 10 • Describe the components of this image of Gram-stained vaginal flora • Mixed bacterial flora predominately Gram positive bacteria • No lactobacillus morphotype • Clue cells; epithelial cells covered in mixed bacterial flora • Epithelial cells (no bacteria attached) • Indicate to which Ison/Hay grade this image belongs • Grade 3 • What clinical condition is this appearance associated with? • bacterial vaginosis