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Objective: The objective of the study is to examine the role of microscopy using stained smears for diagnosis of vulvovavaginal infections:, Design: Description of different scoring systems., Settings: Department of Gynecology and Obstetrics, First Medical Faculty, Charles University; General Teaching Hospital, Prague; Institute of Clinical Chemistry and Laboratory Medicine; Clinical Microbiology and Antibiotic Center, First Medical Faculty, Charles University., Material and Methods: Presentation of our practical skills in microscopic diagnoses of vulvovaginal infections., Conclusions: Vulvovaginal infections are a common problem which we encounter in daily gynaecological practice. Microscopic examination represents the gold standard in the diagnosis of vulvovaginal infections. However, providing microscopy in an outpatient setting is very time-consuming. The vaginal smear can be sent to a laboratory to stain and to be microscopically examined under oil immersion. For this purpose we recommend taking two smears for Gram and Giemsa stain and combining microscopical examination with cultures for detecting the presence of Candida species and for Trichomonas vaginalis. Where appropriate, it is also necessary to obtain cervical smears for detection of C. trachomatis and N. gonnorhoeae infection.

The microscopic characteristic of the vaginal microflora by means of microbial vaginal smears (MVS) according to Jírovec, Peter and Málek corresponds no longer to contemporary ideas on the physiology and pathology of the vaginal environment. The authors revealed on comparison of the results of MVS and the native preparation that in a group of 600 women selected at random the MVS diagnosis allowed to escape 80 cases of trichomoniasis (46.8%), 56 cases of mycotic infections (34.1%) and cases of suspect bacterial vaginosis with the finding of key cells. After elimination of suppurative and non-suppurative bacterial discharge the accurate diagnosis of which involves cultivation, it was revealed that in 156 women (26%) the pathological vaginal discharge was not diagnosed at all or its diagnosis was incomplete. The category of MVS type I, III and V or VI are highly specific but less sensitive. In the category MVS type II the specificity declined substantially, the sensitivity of the test is slightly higher. Predictive values in categories MVS III and MVS V or VI are high, much higher than values obtained in categories MVS I and in particular MVS II. In the diagnosis of vaginal infections transmitted by sexual intercourse native microscopy is irreplaceable. Its assett is rapid and more accurate diagnosis of diobscure findingsseases and the possibility to start immediate and aimed treatment. In case of obscure findings or relapses cultivation is essential.

Microscopic diagnosis of vaginal discharge established so far by means of microbial vaginal pictures (MVP) has proved to be insufficient. Phase contrast microscopy has an irreplaceable value in diagnosing vaginal infections transmitted by sexual intercourse. It yields quick and exact diagnosis of the disease, thus providing the possibility to administer treatment addressly and immediately. In equivocal findings and relapses vaginal cultivation is indispensable. In a series of 600 examined women vaginal trichomoniasis was diagnosed in 28.5% of cases. Simultaneous occurrence of other sexually transmitted diseases was recorded in 42% of 171 women infected with Trichomonas vaginalis. In these cases, the course of the disease was markedly altered by the associated infection. The result of MVP was incomplete or false in 26% of the examined women, trichomoniasis failed to be diagnosed in 80 cases.