MindMap Gallery Medical reproductive tract secretion testing
Mind map about medical reproductive tract secretion testing, including semen testing, prostate testing, Vaginal discharge testing, etc.
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Reproductive tract secretion test
semen test
1. Specimen collection and processing
1. Specimen collection methods: masturbation method, sexual intercourse acquisition method, electric massage method.
2. Sample transportation: Record the collection time and send it for inspection immediately (pay attention to heat preservation in winter).
3. Methodological evaluation: Page P202 Table 8-1
4.Quality assurance
1. Room requirements: In a private room close to the laboratory.
2. Medical staff: Inform the subject of written and verbal instructions on semen specimen collection, emphasizing that semen specimen collection must be complete and that the subject should record the loss of any part of the semen specimen.
3. Patients: They should abstain from sex for 2 to 7 days before collecting specimens for testing, and should urinate first. In order to obtain reliable data, it should be tested 2 to 3 times continuously.
4. Specimen containers: Choose clean, suitable-sized, non-toxic, sterilized plastic or glass containers with lids. It is best to keep the container at 20 to 37 degrees Celsius before and after collection.
5. Specimen collection: Place the discharged semen in a container, record the abstinence time, specimen collection time, whether the specimen collection is complete, etc. If the specimen is incomplete, it should be recorded and noted in the test report, and the specimen should be recollected for testing after 2 to 7 days of abstinence.
6. Specimen submission for inspection: Specimens should be submitted for inspection within 30 minutes after collection. In winter, the specimens should be kept at 20 to 37 degrees Celsius.
5. Specimen Receipt and Rejection
When receiving the specimen, check whether the recorded information is complete, and place the container containing the semen specimen on a constant temperature table or water bath (37 degrees Celsius) to wait for liquefaction. Assess the liquefaction and physical properties of the semen within 30 to 60 minutes. Specimens that do not meet the requirements should be rejected and recorded.
6. Post-inspection specimen processing
The semen specimens and containers that have been tested should be incinerated or autoclaved together and then processed centrally, or the semen should be poured into 1000mg/L chlorine-containing disinfectant and soaked for 30 minutes before being discarded.
2. General trait inspection
(1) Color: gray or milky white, opaque
Red/soy sauce color with a large number of red blood cells is hematospermia:
seminal vesiculitis
prostatitis
reproductive system tuberculosis
tumor
stone
Yellow purulent semen is seen in prostatitis or seminal vesiculitis
(2) pH
1. Testing method pH test paper method
2. Reference interval 7.2-8.0
3. Clinical significance. Alkaline when pH>8.0: seen in acute prostatitis, seminal vesiculitis or epididymitis; pH<7.0 such as dysplasia
(3) Quantity
1. Reference interval: 2 to 6 mL of semen discharged at one time
2. Changes in semen volume and clinical significance
1.Semenopenia
Seen in insufficient androgen secretion and paragonadal infection
2.Azoospermia
No semen discharge
3. Spermia
Seen in accessory gland hyperfunction
(4) Liquefaction time
Definition: Refers to the time required for the jelly-like state of semen to change into a flowing liquid after discharge.
1. Inspection method.
naked eye observation
dropper method
2. Methodological evaluation:
The dropper method has better results accuracy and repeatability than the naked eye observation method.
3.Quality assurance
Accurate records
Keep in a constant temperature environment of 37 degrees Celsius and observe every 5 minutes
4. Reference interval
Liquefaction time<30min
The semen coagulates immediately after ejaculation. Usually the semen begins to liquefy 5 to 10 minutes after it leaves the body, and is completely liquefied in 30 minutes. The liquefaction time is less than 30 minutes.
5.Clinical significance
1. Semen coagulation disorder
Seen in seminal vesiculitis or vas deferens defects
2. Incomplete liquefaction
Seen in prostatitis
(5) Viscosity
1. Inspection method
Dropper method (easier to observe, results)
glass rod method
2. Reference interval
Drawing length<2cm
3.Clinical significance
reduced viscosity
Such as congenital seminal vesicles, low sperm concentration or spermatosis
Increased viscosity
Such as epididymitis, prostatitis
3. Chemical and immunological tests
(1) Chemical testing Methods and clinical significance of chemical testing of semen Page P204 Table 8-3
(2) Immunological tests
The blood-testis barrier exists in the male reproductive tract
Samples for anti-sperm antibody testing can be serum, seminal plasma and cervical mucus
Anti-sperm antibody test method
mixed antiglobulin reaction test
Direct and indirect immunobead assays
Sperm agglutination test
sperm immobilization test
Immunoglobulin test
4. Microscopic examination
(1) Sperm motility
1. Inspection method
Take 1 drop of the mixed liquefied semen and add it to the glass slide. After adding a cover slip, first observe with a low-power microscope, then use a high-power lens to observe and count.
2. Methodological evaluation
The continuous photography method is recommended by WHO and is intuitive and highly accurate, but requires high-precision equipment.
3.Quality assurance
1. Specimen 2. Equipment 3. Temperature 4. Mixing 5. Production 6 High magnification counting
4. Reference interval
Total sperm motility (PR➕NP) is greater than or equal to 40% Forward motility sperm (PR) is greater than or equal to 32% PR: forward motility sperm NP: non-prograde sperm
5Clinical significance
Sperm motility and pregnancy rate Related to low mobility seen in
varicocele
Non-specific infection of reproductive system
6. Sperm motility grading standards
level a
good mobility
Sperm moves forward in a straight line
Class B
Better mobility
Sperm move slowly and sluggishly forward, but sometimes rotate
c level
poor mobility
Sperm moves slowly, shaking in a swirling manner
Class D
No activity
Sperm are completely inactive and remain inactive after heating, that is, dead sperm
(2) Sperm motility rate
1. Test method: Same as sperm motility test
2. Methodological evaluation: Generally it can only be used as a preliminary screening test method
3. Quality assurance: Same as sperm motility test. If there are too many immotile sperm (>75%), in vitro sperm staining should be used
4. Reference interval: Within 60 minutes of semen ejaculation, the sperm survival rate is 80%~90% (at least >60%) If the sperm survival rate is less than 70%, fertility may be reduced; if it is less than 40%, it may lead to infertility.
5. Clinical significance: Factors causing the decrease in sperm motility rate include
1. Varicocele
2.Reproductive system infection
3.Physical factors
4. Chemical factors
5.Immune factors
(3) Sperm survival rate
1. Testing method: eosin staining method; hypotonic expansion sperm motility test
2. Methodological evaluation
staining method
The operation is simple and fast, the results are accurate and the repeatability is good. However, the background contrast is poor and the lightly stained sperm cannot be distinguished clearly.
Hypotonic swelling sperm motility test
The operation requires relatively complex equipment, and the test results There is a good correlation with sperm function tests.
3.Quality assurance
1. In order to reduce errors, at least 200 sperm should be counted for each specimen.
2. Each specimen is tested twice at the same time. When the results of the two tests are inconclusive, When there is a statistical difference, the mean value is reported, otherwise the test should be re-tested.
3. The sperm survival rate should be assessed as soon as possible after liquefaction. Proceed quickly and must be completed within 1 hour after ejaculation.
4. Reference interval: greater than or equal to 58%
5. Clinical significance: Reduced sperm survival rate is one of the important indicators of male infertility. When the sperm survival rate is less than 40%, it can lead to infertility.
(4) Sperm agglutination
1. Reference interval: no agglutination ~ level 1. See Table 8-4 on page P207 for grading of sperm agglutination.
2.Clinical significance
1. The presence of agglutination does not determine that the cause of infertility is immune, but there may be anti-sperm antibodies, and further examination should be conducted to confirm the diagnosis.
2. Severe sperm agglutination can affect the assessment of sperm motility and density.
(5) Sperm count
1. Inspection method: microscopy technique
2. Methodological evaluation: See Table 8-5 on page P207 Methodological evaluation of sperm counting
3.Quality assurance
1. Specimens
2. Count
4. Reference interval
Sperm density is greater than or equal to 15x10 raised to the 6th power/ml The total number of sperm is greater than or equal to 39x106 sperm/1 ejaculation
5.Clinical significance
Decreased sperm concentration or azoospermia is seen in
1.Testicular diseases
2. Vas deferens disease
3.After male sterilization surgery
4.Others
(6) Sperm morphology
1. Inspection method: wet film test; smear dyeing test
2. Methodological evaluation: smear staining test, recommended by WHO
3. Reference range: Normal morphological sperm: 4% ~ 44% (Abnormal sperm should be less than 20%, if more than 20% is abnormal)
4.Clinical significance
An increase in abnormal spermatozoa is seen in
1. Varicocele
2.Reproductive system infection
3. Androgen abnormalities
4. Certain drugs, genetics, etc.
(6) Non-sperm cells
1. Reference interval
1. Spermogenic cells: <1%. 2. White blood cells: 1.0x10 to the 9th power/L or <5/HP 3. Occasionally see red blood cells
2.Clinical significance
Increased red blood cells and white blood cells in semen
1. Reproductive system inflammation
2. Tuberculosis
3. Malignant tumors
Cancer cells found in semen
Malignant tumors of the reproductive system can be diagnosed
Prostate test
1. Specimen collection and processing
1.Color: Opaque milky white liquid
2. Prostatic fluid detection is used in: auxiliary diagnosis of prostatitis and other diseases, observation of therapeutic effects, and can also be used for the diagnosis of sexually transmitted diseases.
3. Specimen collection and transportation: Clinicians perform prostate massage to collect specimens. Specimens are collected in clean, dry, covered specimen boxes. Specimens used for microbial culture should be collected aseptically and sent for inspection immediately.
4. Specimen acceptance and rejection: When accepting specimens, first observe whether the specimen meets the inspection requirements. If the specimen quantity is insufficient, the specimen is not submitted in time, or the material is poorly obtained, etc., the specimen should be refused and the corresponding record should be made, and the submitting department should be notified at the same time.
2. General trait inspection
1. Quantity
Normal adult prostate volume is: 2mL
Reduced prostate volume
Seen in prostatitis
increased secretion
Seen in chronic congestion of the prostate
2. Appearance
Color: Milky white, thin, opaque glossy liquid
Red (indicating bleeding)
Seen in seminal vesiculitis, prostatitis, prostatic tuberculosis Stones or malignant tumors
Yellow turbid, purulent and sticky (severe infection)
Seen in prostatitis or seminal vesiculitis
3. Microscopic examination
1. Inspection method
Wet mount test (commonly used clinically)
First observe the entire smear with low power, then observe with high power. Type, quantity and form of tangible components.
Smear stain test
When abnormalities, giant cells or suspected tumors are seen, microscopic examination should be performed after staining. Differentiate between prostate tumors and prostatitis. If an increase in eosinophils is found, a diagnosis of hypersensitivity prostatitis can be considered.
2. Reference interval:
Phosphatidylchophore bodies: numerous, evenly distributed in the visual field; Prostatic granulosa cells: <1/HP; red blood cells: <5/HP; white blood cells: <10/HP
3. Tangible components and clinical significance: P Page 203, Table 8-9
4. Quality Assurance of Prostatic Fluid Testing
A large number of phosphatidyl choledosomes observed under a high-power microscope
Uniform distribution over the full field of view can be reported as 4➕
Occupying 3/4 of the field of view is 3➕
Occupying 1/2 of the field of view is 2➕
Very few in number and unevenly distributed, occupying 1/4 of the field of view 1➕
Vaginal discharge test
1. Specimen collection and processing
Vaginal discharge: leucorrhea
collection
Secretions are collected from the orifice of the cervix, the back of the vaginal vault, and the depth of the vagina, and are placed in test tubes for immediate examination.
Specimen Receipt and Rejection and Post-Test Specimen Handling: Same as Prostate Test
2. General trait inspection
Appearance and clinical significance Page P215, Table 8-10
3. Microscopic examination
1. Cleanliness: refers to the level of vaginal cleanliness, which is judged by the number of lactobacilli, epithelial cells, white blood cells and miscellaneous bacteria in vaginal secretions. It is an indicator of vaginal inflammation and ovarian function in women during childbearing period. 1.1 Clue cells: The surface of epithelial cells is rough, with spots and a large number of fine particles.
2. Reference interval: I-II degrees Normal cleanliness level III, no trichomonas, no or occasional fungi, Lactobacilli 6-30/HPF or >30/HPF, no pathogenic bacteria and special cells.
3. Criteria for judging vaginal cleanliness Table 8-11 on page P215
4. Gardnerella and clue cells
GV
BV (bacterial vaginosis)
thin vaginal discharge
PH>4.5
Amine test positive
cue cells
the difference
bacterial vaginosis
Gardnerella anaerobic bacteria increased and lactobacilli decreased
nonbacterial vaginosis
Lactobacillus >5/HPF A little Gardnerella
5. Neisseria gonorrhoeae
Neisseria gonorrhoeae are gram-negative diplococci Kidney-shaped or coffee bean-shaped
Testing method
1. Smear Gram staining method
2.Cultivation method
3.PCR method