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Test your ability to read Gramstained genital samples
What you need to do
• You are about to view 10 images of Gramstained 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
Slide 1
1. Describe the components of this image of Gram-stained vaginal flora
2. Indicate to which Ison/Hay grade this image belongs
3. What is the clinical significance of this appearance?
Answer Slide 1
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
Slide 2
1. Describe the components of the image (this is a male urethral sample)
2. What clinical condition is this appearance associated with?
Answer Slide 2
1.
Describe the components of the image
•
Polymorphs >30 per high power field
•
Occasional epithelial cell
•
No bacteria seen
2.
What clinical condition is this appearance associated with?
•
Non-gonococcal urethritis
Slide 3
1. Describe the components of this image of Gram-stained vaginal flora
2. Indicate to which Ison/Hay grade this image belongs
3. How would you report these findings?
Answer Slide 3
1.
Describe the components of this image of Gram-stained
vaginal flora
•
•
•
2.
•
Epithelial cells
Gram positive bacilli (rods) –lactobacillus morphotypes
Gram negative bacilli (rods)
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
Slide 4
1. Describe the components of this this image of Gram-stained vaginal flora
2. Indicate to which Ison/Hay grade this image belongs
3. What are the symptoms classically associated with this appearance?
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)
Slide 5
1. Describe the components of this image of Gram-stained vaginal flora
2. Indicate to which Ison/Hay grade this image belongs
3. How would you report these findings?
Answer Slide 5
1.
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
3.
How would you report this appearance?
•
Intermediate flora
Slide 6
1. Describe the components of the image of this Gram-stained
cervical sample
2. How would you report this appearance?
Answer Slide 6
1. 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
Slide 7
1. Describe the components of this image of Gram-stained vaginal flora
2. Indicate to which Ison/Hay grade this image belongs
3. How would you report this Gram-stained vaginal smear?
Answer Slide 7
1.
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
Slide 8
1. Describe the components of this image of Gram-stained vaginal flora
2. What clinical condition would fit with this appearance?
Answer Slide 8
1.
•
•
•
•
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
2.
•
What clinical condition would fit with this appearance?
Candida sp infection
Slide 9
1. Describe the components of the image
2. How would you report this appearance?
Answer Slide 9
1. Describe the components of the image
• Polymorphs
• Occasional epithelial cell
• Intracellular Gram negative cocci
• Extracellular Gram negative cocci
• Gram negative bacilli (rods)
2. How would you report this appearance?
• Presumptive diagnosis of gonorrhoea
Slide 10
1. Describe the components of this image of Gram-stained vaginal flora
2. Indicate to which Ison/Hay grade this image belongs
3. What clinical condition is this appearance associated with?
Answer Slide 10
1.
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)
2.
Indicate to which Ison/Hay grade this image belongs
•
Grade 3
3.
What clinical condition is this appearance associated with?
•
bacterial vaginosis