I often have friends with white belt test forms to ask me if the results are abnormal. Reading the inspection report is a technical activity, although a lot of information can be searched on the Network, but it is always true and false, and non-professionals are easily confused by unreliable content.
So, if you don't have a (reliable) friend like me, is it possible to read the white belt test form on your own? Then see if this article can help you!
Significance of routine examination of vaginal discharge
Every patient with abnormal discharge or symptoms of vulvovaginal discomfort visits a gynecological clinic, the vaginal discharge routine is a mandatory item. Women who do not have symptoms of discomfort often check for vaginal discharge after pregnancy, before gynecological surgery, and during health checkups.
The test is so widely used that most of the time the purpose is simple: to screen or exclude the three most common vaginal diseases: bacterial vaginosis, vulvovaginal candida disease (commonly known as fungal vaginitis), and trichomoniasis vaginitis.
BV, mold, trichomoniasis
Most routine vaginal discharge tests include mold (or candida) and trichomoniasis options. As the name suggests, it corresponds to two diseases: fungal vaginitis and trichomoniasis vaginitis.
Some tests also have a "BV" item on the test, referring to bacterial vaginosis. If there are these three items on the test sheet, and one of them is abnormal, then even if you do not look at other test items, you can make a preliminary diagnosis of the corresponding vaginal disease and formulate a further treatment plan.
Unlike mold and trichomoniasis, the diagnosis of bacterial vaginosis is sometimes not so intuitive. If there is no BV item on the test form, it is necessary to make a comprehensive judgment on more test items.
Bacterial vaginosis is essentially a disturbance of the microflora in the vagina, with a decrease in lactobacilli, loss of inhibitory effect on other bacteria, and overbreeding of anaerobic bacteria such as Gardnerella, resulting in bacterial vaginosis.
The most commonly used diagnostic criteria for bacterial vaginosis are the Amsel criteria [1,2]:
Cue cells positive (refers to a large number of anaerobic bacteria adhering to vaginal epithelial cells, which are characteristic cells of bacterial vaginosis);
pH＞4.5；
positive amine test (refers to the characteristic fishy odor produced by bacterial vaginosis);
Uniform, thin gray discharge adheres to the vaginal wall
At least three of the above four points can be diagnosed as bacterial vaginosis.
Other inspection items
Many times, the results of routine vaginal discharge tests are not enough to diagnose a certain type of vaginitis, but not all items are within the normal range, so what do these abnormal results mean?
Cleanliness
This is perhaps the most confusing check item, many people have other items are normal, only the white belt cleanliness is always abnormal, and then become a thorn in the heart.
Cleanliness is actually only a corroboration of the state of vaginal discharge, the normal range of I and II degrees indicate that there are more lactic acid bacteria in the secretion, less bacteria, less bacteria, white blood cells, and the III and IV degrees that are considered abnormal indicate that there are fewer lactic acid bacteria, and there are more bacteria and white blood cells.
This is a relatively extensive classification method, the number of lactic acid bacteria, miscellaneous bacteria, white blood cells is easily affected, such as vaginal medication, sexual life and so on. If there are no symptoms of discomfort, other test items are normal, and only abnormal cleanliness does not explain anything.
pH
Vaginal pH is also a test item used as a reference.
Under normal circumstances, the pH of the vagina is generally between 3.8 and 4.5, and when bacterial vaginosis and trichomoniasis vaginitis occur, the pH tends to rise to more than 4.5, while fungal vaginitis often does not lead to abnormal pH.
However, this project can only be used as a reference, not as conclusive evidence for diagnosis, also because it is easily affected by other factors, such as postmenopausal women because of changes in the hormonal environment in the body, vaginal self-protection ability to reduce, pH will increase.
Women of childbearing age often change the pH of the vagina (usually elevated) if they have vaginal medication, irrigation, sexual life, and amniotic fluid leakage in pregnant women.
hydrogen peroxide
This check is a bit of a detour.
Under normal circumstances, lactobacilli in the vagina produce hydrogen peroxide, bacteriocins and other active factors to inhibit the growth of heterobacterial bacteria, so it is normal to detect hydrogen peroxide in the vaginal discharge, indicating that lactobacillus is working normally.
So does the "positive hydrogen peroxide" on the test form indicate that this indicator has passed? Not. Positive hydrogen peroxide refers to insufficient hydrogen peroxide production, and negative hydrogen peroxide indicates adequate hydrogen peroxide production. Well...... I don't know why the test sheet is playing this counterintuitive game of shaking your head yes and nodding no.
Leukocyte esterase
This is an enzyme present in white blood cells that, when elevated, indicates an increase in white blood cells in the vagina. White blood cells are the main force of the immune system, which has it to resist pathogens and repair damaged tissues.
Therefore, if the leukocyte esterase is elevated, it may be due to vaginal inflammation, it may also be because of other reasons, if there are no symptoms of discomfort, no other abnormal test results, it is also a negligible indicator.
Sialidase
It is an enzyme produced by Gardnerella and other anaerobic bacteria, which, when positive, indicates that there are more bacteria multiplying, and is also an auxiliary diagnostic item for bacterial vaginosis. If only this one is positive, other items are negative, and there are no discomfort symptoms, it means that lactic acid bacteria have not been in a dominant position for the time being, and there are a lot of bacteria, and it can be expected to return to normal naturally.
If this item is positive at the same time as the previous item, it means that not only are there more bacteria, but the vaginal mucosa may also have an inflammatory response, so the possibility of bacterial vaginosis is higher.
Many friends may have observed that the amount and traits of vaginal discharge change regularly with the menstrual cycle. The amount of vaginal discharge during ovulation and before menstruation will increase, the vaginal discharge during ovulation is thinner and more transparent, and the premenstrual period is mostly whitish and viscous, and these changes are the result of the secretion being affected by hormones.
Sometimes, vaginal discharge doesn't seem to vary so strictly according to the menstrual cycle. This is because in addition to hormones, vaginal discharge is also affected by diet, medication, sex and other factors. In addition to vaginitis, cervicitis, pelvic inflammatory disease and other diseases may also cause abnormal vaginal discharge.
Therefore, the vaginal discharge may change color, may have a slight fishy smell or be affected by food and drugs, carry some special taste, and may also have a slight irritation of the vulvar mucosa, making people occasionally mildly itchy, which is normal.
If this is the case, and the white belt test form is not obviously abnormal, there is generally no need to worry. If there is persistent itching, pain, burning, or other obvious discomfort, or if there is a significant abnormality on the vaginal discharge test, further diagnosis and treatment plans need to be formulated on a case-by-case basis.
【Reference】
Guidelines for the diagnosis and treatment of bacterial vaginosis (2021 revised edition)[J].Chinese Journal of Obstetrics and Gynecology,2021,56(01):3-6.
[2] Sexually Transmitted Diseases Treatment Guidelines, 2015[J]. Morbidity and Mortality Weekly Report: Recommendations and Reports,2015,64(3).
Source: Pediatrician Kong Lingkai
Edited by: Yeah Reviewer: Xiao Ran