Dr. Hughey discusses the development of this video. He covers some technical issues he encountered during the project, and solutions that worked and those that didn’t.
He reviews the good things and the not so good things about the video, and those things he would do differently today with the video.
Behind the Scenes
The Original 5 Minute Wet Mount Video
Behind the Scenes Script
When I was in training 35 years ago, this wet mount technique was practiced and carefully learned in the outpatient clinics, where patients with vaginitis were plentiful.
Then, as now, diagnosis suggested by symptoms and physical appearance of a discharge were more often correct than incorrect, but were wrong a fair amount of the time. When trained, we could use the wet mount test to reliably distinguish yeast from trichomonas from bacterial vaginosis (which we called gardnerella, or sometimes nonspecific vaginitis).
This technique is less used today, having been replaced by various dipsticks, PCR swabs, and cultures. I’m fine with that as far as diagnostic accuracy is concerned, but all of these replacement tests are a lot more expensive, and several of them require time for you to obtain your diagnosis.
While the focus of the video was on obtaining and reading a wet mount, I wanted to provide some visual examples of conditions one might encounter when thinking about a wet mount, including herpes, cervical cancer and Chlamydia.
I also wanted to show visual examples of yeast and trichomonas to help the students develop a sense that not all discharges look the same,…and that some subtle but recognizable differences can point them toward the correct diagnosis.
In portraying the preparation of the discharge, I used a thin mixture of water and cornstarch. This looks a lot like vaginal discharge and if not thoroughly mixed, has some lumpiness to it that extends the simulation.
Getting the microscopic images of the different organisms took some time. I collected specimens over time and tried a series of them to catch the best examples.
Unlike looking at still images, the actual technique used for microscopy involves focusing up and down through the plane of the yeast or trichomonad, creating a 3-dimensional image in your mind. That’s the main reason I favored showing video of the microorganisms rather than still pictures…so the students would understand that a still image depends on the plane of the image.
For BV, I had a pretty good image of a normal vaginal epithelial cell, but I had a lot of trouble finding a good example of a clue cell, with it’s covered-in-sand appearance. I used the best one I had. I wish it were better.
I had a lot of trouble getting the trichomonas video. I thought it would be the easiest to show, but I was wrong. I hadn’t factored in the delay between when I collected the specimen and the time when I could actually perform the video microscopy.
Even strong, vigorous trichomonads wear out over time, and I was pressing the edge of the envelope with my time restrictions. Once I realized the problem, I tried keeping the trich sample warm, but that didn’t help. Then I tried keeping the sample cool until I was ready to warm them up for the photography. That worked better.
In the end, I had some recognizable trichomonads that were OK but not the best examples. But OK was better than nothing, so I went with it. If I were doing it today, I would try harder to get better examples of trich.