1. Urinalysis, urine culture. Obtain both studies if UTI is suspected (see Chapter 91, Urinary Tract Infection, p. 425). Presence of leukocytes, leukocyte esterase, nitrites, erythro-cytes, or bacteria on urinalysis is highly indicative of UTI. Erythrocytes alone can be seen with renal calculi. Bacteria or yeast alone may be detected in urine specimens due contamination by normal flora of vagina and urethra.
2. CBC with differential and blood culture. Order in all patients who are ill-appearing and are admitted (see also Chapter 91, Urinary Tract Infection, p. 426).
3. Urethral discharge. Obtain Gram stain and culture on Thayer-Martin medium. Presence of intracellular, gram-negative diplo-cocci on Gram stain requires empiric treatment for gonorrhea. Always evaluate for the possibility of coinfection with Chlamydia. Giemsa stain will show cytoplasmic inclusion within epithelial cells if infection is present. Alternatively, discharges can be sent for DNA probe for C trachomatis and Gonococcus.
4. Urine test for N gonorrhea and Chlamydia. Less-invasive method of diagnosing these organisms. Involves a ligase chain reaction. Test looks for the presence of both organisms and amplifies their DNA if present.
5. Vaginal discharge. Use wet mount to look for T vaginalis, which has flagella and moves rapidly and erratically. Clue cells (activated squamous cells coated with bacteria) indicate bacterial vaginosis. Presence of hyphae indicates infection with C albicans.
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