Vaginal wet mount
||It has been suggested that this article be merged with High vaginal swab. (Discuss) Proposed since March 2016.|
A vaginal wet mount (or vaginal smear or wet prep) is a gynecologic test wherein a sample of vaginal discharge is observed by wet mount microscopy by placing the specimen on a glass slide and mixing with a salt solution. It is used to find the cause of vaginitis and vulvitis.
Vaginal wet mounts are used in case of vaginitis symptoms such as vaginal itching, burning, rash, odor, or discharge. It may assist in suspicion of vaginal yeast infection, trichomoniasis and bacterial vaginosis.
Vaginal wet mounts are not done during the menstrual period, because menstrual blood on the slide can confound the results. Vaginal irrigation, tampon use or sex (potentially disrupting the vaginal pH) should be avoided for 24 hours before the test. Vaginal medicines (such as a nonprescription vaginal yeast medicine) should not be used during the 2 to 3 days before the test.
The sampling is done with the patient in lithotomy position. A speculum is used to facilitate use of a swab or spatula to sample fluid inside the vagina. The sampling procedure may cause some discomfort and minor bleeding, but otherwise there are no associated risks. The sample is then smeared upon a microscope slide and is observed by wet mount microscopy by placing the specimen on a glass slide and mixing with a salt solution.
Symptoms of infections able to be diagnosed by wet mount:
- diagnosis is made if pseudohyphae or yeast buds are present (these are visible only 50% of the time)
- Diagnosis is made if mobile trichomonads are visible on the slide
- Bacterial vaginosis generally produces a vaginal discharge that is thin and milky with a fishy odor.
- Diagnosis is made if >20% of cells are clue cells AND two of the following three criteria are met (Amsel's Criteria):
- Discharge is thin and homogeneous
- Sample smells fishy when mixed with potassium hydroxide ("whiff test")
- Vaginal pH is >4.5
Concomitant vaginal discharge tests
A vaginal discharge sample wet mount is often also used for the following additional tests:
- KOH slide. A sample of the vaginal discharge is placed on a slide and mixed with a solution of potassium hydroxide (KOH). The KOH kills bacteria and cells from the vagina, leaving only yeast for easier detection of a yeast infection. Several drops of a potassium hydroxide (KOH) solution may also be added to a sample of the vaginal discharge to test for any resultant strong fishy odor from the mix, which would indicate bacterial vaginosis. The latter procedure is called a Whiff test. 
- Vaginal pH test. The normal vaginal pH is 3.8 to 4.5. Bacterial vaginosis, trichomoniasis, and atrophic vaginitis often cause a vaginal pH higher than 4.5.
If indicated, the sample can also be used for:
- Detecting atrophic vaginitis by additional staining.
- Vaginal culture, to see if bacteria, yeast, or trichomonads will grow.