PRACTICE OF ROUTINE VAGINAL SWAB TEST AND URINALYSIS IN FEMALES OF CHILDBEARING AGE IN ENUGU METROPOLIS.

1.0. INTRODUCTION The general issue of concern of this research is to know how important women deem the issue of routine vaginal swab test, and urinalysis, and how often they carry out these tests. These two tests which are used to detect infections, diseases, and other abnormalities, are normally taken for granted. But, it cant be said for sure if more women deem it important, or if more women deem it unimportant, hence the essence of this research literature review. In common English, urinalysis is the chemical analysis of urine. Urinalysis is the testing of the physical characteristics and composition of freshly voided urine change dramatically as a result of disease processes (Helen Okoye, 2012). The urine may contain red blood cells, glucose, protein, white blood cells, or bile. The presence of such abnormalities in urine is an important warning sign of illness or disease, and may be helpful in clinical assessment. Urinalysis can also be defined as the examination of specimen of urine to rule out abnormalities (Nursing procedure book for department of Nursing sciences, UNEC. Page 101). It reveals diseases ha t have gone unnoticed because they do not produce striking signs or symptoms (library.med.uta.edu/edu. online). It is a physical, chemical, and microscopic examination of urine (www.nim.nlh./gov). Urinalysis also called Routine and microscopy(RM) is an array of tests performed in urine , and one of the most common tests used to diagnose and prevent abnormalities. A vaginal swab test is another one of such tests used to detect infections or abnormalities. It is also called a Pap smear test. It is done to test for infection in the vaginal area, as well as other abnormalities of the vaginal wall and cervical cells (www.reference. com). The vagina is a portion of the female genital tract. It is mostly free of primary disease. In the adult female, inflammations often affect the vulva and perivulvar structures and spread to the cervix without significant involvement of the vagina. Primary lesions of the vagina are rare. The most serious of which is primary carcinoma. The vaginal swab tests can be used o test for such disease and this helps prevents further damage to the female genitals. The term vaginal swab is usually used to indicate a type of test performed on a womans genitals (www.wisegeek.com/what is a vaginal swab test.) The issue of vaginal swab tests and urinalysis, which are like the most common tests used to detect or check for infections have been written about and discussed by various authors in various books, textbooks, and in various seminars, and lectures. Note that these tests are used not for treatment of infections or diseases, but for diagnosing and preventing infections and diseases. It It has most likely been drawn to a conclusion from some of these works that vaginal swab tests and urinalysis should be done like once a year (Mayo clinic family health book, 4th edition). Some other works have indicated having the texts done like twice a year.

Though there was no research work found on the issue of routine vaginal swab tests and urinalysis, there have been books, topics of discussions as found in textbooks, and other articles on the internet about these tests, and how other health professionals deem it. Some women dont even know how often they should carry out these tests or even about the tests. This literature review is therefore aimed at enlightening people on the importance of these tests, thereby encouraging women to carry out the tests. In conclusion, the sequence of this review is: 1.) 2.) 3.) 4.) 5.) 6.) To know what exactly vaginal swab tests and urinalysis are. To know when it should be done. To know how it is being carried out. To know who carries it out. Precautions taken during the tests Most importantly, know its importance in detecting abnormalities.

Appropriate evaluation of any abnormality can assist in detecting serious underlying diseases (www.health communities.com). 1.1. URINALYSIS According to med line plus, urinalysis is the medical examination of urine involving evaluation of the urines color and appearance , observing the urine under a microscope , and a chemical analysis using a attest strip called a dipstick. The presence of unexpected substances in the urine causes markers on the dipstick to change color. One substance detected using the dipstick is white blood cells, also called leukocytes. The term pyuria means the abnormal presence of white blood cell in urine. Although, pyuria typically indicates an infection in the bladder or kidneys, White blood cells in the urine can occur for some other reasons which include proteinuria, and haematonuria. 1.1.1. INDICATIONS FOR URINALYSIS 1. To determine the individuals urine status if the individual is on admission, as a baseline for comparisons until further assessment is carried out. 2. To monitor changes in urinary constituent as a response to medication. 3. To be used as a screening test to gather information about a physical status. This is more of a routine testing which should be carried out by women. 1.1.2. CONSTITUENTS OF URINE. The main constituents of urine are 1. 2. 3. 4. 5. Urea Water Uric acid Creatinine Aminoic

6. 7. 8. 9. 10. 11. 12. 13.

Sulphates Sodium Potassium Chloride Calcium Magnesium Phosphates Hormones, and vitamins Other constituents indicative of diseases include; red blood cells, white blood cells, casts, crystals, mucus, bacteria, protein, glucose, and ketone. 1.2. VAGINAL SWAB TEST.

A Vaginal swab test involves taking a sample of vaginal secretions with a device that looks like a cotton bud. The swab, with secretions attached, is then placed in a special container and sent to the microbiology laboratory for further analysis. When it reaches the laboratory, the sample is then placed in a special incubator that maintains a particular level of heat and humidity, which facilitates the growth of any bacteria that may be contained in the sample. The jelly in the Petri dish is a nutrient material that allows any bacteria in the sample to colonize the surface of the jelly. This is the process that is referred to when a swab is sent for culture test. In other words, the lab technician is attempting to make the bacteria reproduce and multiply by creating a favorable, yet artificial environment. Having succeeded in creating the bacterial colonies on the Petri dish, various antibiotics are then added to the dish to determine which antibiotics are the most effective in eliminating the bacterial colonies from the dish. This test is a preventive/promotive type of health care delivery; it prevents and diagnoses infections/abnormalities/diseases. It does not treat.

2.0. HISTORICAL BACKGROUND 2.1. HISTORY OF URINALYSIS Urinalysis was the very first laboratory test developed. The value of urine testing to diagnose medical conditions was established over 6,000 years ago. There is evidence of visual testing of the urine in the earliest civilizations. As advances in medicine proved visual testing to be inadequate, chemical evaluation of the urine replaced this method as a mere accurate means of diagnosis. Over 600years, Paracelsus, as well as others began to reject ancient dogma and searched for a new approach to the analysis of urine by using chemical distillation techniques. Further understanding of the structure of the body (anatomy), and of the physical and chemical processes, involved in an organ function (physiology), as well as the invention and development of the microscope, led to additional advances in urine testing as a diagnostic tool.

Urinalysis was first introduced as part of the routine physical examination in 1827, and this test remains a valuable method of diagnosis. The ability to test large numbers of urine samples (through automation) and recent advances in chemical and microscopic techniques [E.g.; monoclonal antibody testing (used to identify infectious organisms)} have improved the effectiveness of urine testing.

3.0. PROCEDURES OF VAGINAL SWAB TEST AND URINALYSIS 3.1. PROCEDURE OF VAGINAL SWAB TESTS. This test is not painful, however, many doctors advice younger women who have the test that they will feel a little uncomfortable during the testing. The test does not take long to complete. First, the doctor will instruct the individual to lay back and relax, placing the feet on the stirrups at the end of the exam table. Then, using a light and a reverse clamp looking tool called a speculum, the doctor 9or whoever is performing the test) will spread the walls of the vagina to look inside. The doctor will then collect vaginal samples with an elongated Q-tip looking tool, as well as a small bristled looking tool. After the doctor has his/her sample, they will feel around the inside of the vagina to ensure that there are no lumps or abnormalities within the ovaries or uterus. 3.2. PROCEDURE FOR URINALYSIS Urinalysis is an essential part of health assessment for both diagnostic and preventive purposes. It has different ways by which it could be done. Although laboratories provide a wide range of urine tests, urinalysis can also be performed outside the laboratory setting with tablets, dip-sticks, and tapes. 3.2.1. CLEAN CATCH SAMPLING Urinalysis may be performed using a clean catch sample of urine. To achieve this, the area surrounding the opening of the urethra is cleansed and rinsed well. A small amount of urine should then be allowed to fall into the toilet and the rest should then be collected midstream in a clean container. This test should be performed within 15 minutes of collecting the urine sample. If it isnt possible for this to be done, then the urine should be put in a fridge. Some parts of routine urinalysis are performed using different other methods which are not done in laboratory settings. 3.2.2. DIPSTICK TESTS This involves placing papers that contain small pads of chemical into the urine sample. These papers the change color when exposed to various substances in the urine. This type of urine testing can result in false positive or false-negative results.

3.2.3. TABLET TESTS This type of test use the same principle as the dip sticks tests. The only difference is that instead of papers, tablets are used. These tablets are moistened with urine, and react in response to various substances. 3.2.4. MICROSCOPIC TESTS This includes checking for bacteria and other microorganisms, blood cells, casts(hyaline, granular), cells from the lining of the urinary tract(epithelial cells), and renal tubular cells. 3.3. WHO PERFORMS THESE TESTS? A vaginal swab test and urinalysis are performed by different health / medical practitioners. 1. Nurses, who act on physicians orders. 2. Medical laboratory scientists. 3. Doctors, called gynecologists, or obstetricians, for women who are pregnant. Both doctors have been specially trained to ensure that everything in the female reproductive system is working correctly and looks normal. Urinalysis and Vaginal swab tests are kinds of specimen collection. 4.1. SPECIMEN COLLECTION The collection of specimen is done by health or medical practitioners. Specimen collection of the collection of the required amount of tissues of fluid for laboratory examination to allow for the isolation and identification of microorganism that causes disease and to determine their anti-microbial sensitivity to a guide in the selection of appropriate anti-microbial therapy. It is required when microbiological, biochemical, and other laboratories investigations are indicated. Successful laboratory diagnosis is obtained when appropriate sample is collected with he required equipments and techniques and transporting it to the designated laboratory without delay. Therefore, the sample must be representatives of the disease process. Nurses often assume the responsibility of specimen of collection which consists of urine, stool, discharge, blood, and wound. 4.1.1. PRECAUTIONS IN SPECIMEN COLLECTION 1.) Appropriate investigation to be undertaken should be known, so as to prevent indiscriminating of specimen being collected. 2.) Desired specimen should be collected in a correct container. The more the specimen, the greater the chance of isolating the causative organism. 3.) Patients physical, psychological, and emotional status should be checked.

4.) Aseptic technique must be used in collecting specimen to prevent contaminating the sites of sample or the specimen. 5.) Gloves are to be worn when collecting or handling specimen. 6.) Samples should be collected before beginning any treatment. 7.) Prompt delivery of specimen to prevent error in d result because the sooner the specimen arrives, the greater the chances of investigating the surviving organism. If they cant be transported immediately, they can be stored in a 37 degree incubator, or specimen refrigerator at 4 degree centigrade, depending on the type of specimen. 8.) Specimen should be labeled correctly and clearly. 9.) Specimen should be stored correctly to avoid changes that will affect the result. 10.) Normal values and measurements required should be known, so as to detect variations. 4.2. FINDINGS Some findings from the vaginal swab tests include: 1.) 2.) 3.) 4.) 5.) Bacterial vaginosis Trichomoniasis Yeast infection Harmless Bacteria Sexually transmitted diseases(STDs)

Some findings from routine urinalysis include: 4.3. RATIONALE FOR THESE CLINICAL CHECK-UPS 1.) In the case whereby the either of these tests was recommended by a doctor, there should be a justifiable or reasonable justification for requesting clinical investigation. This is because of the cost of money, time, and anxiety to the patient. 2.) These tests provide a clue with which the individuals health is assessed at a point in time. 3.) It is used to exclude or confirm the suspected diagnosis following a physical examination 4.) It helps to monitor a patients clinical status especially when they undergo therapeutic regions, as it reveals trends in health and well-being. 4.4. RELATED TESTS. 4.5. SOME REASONS WHY WOMEN DO NOT GO FOR THESE TESTS.

First of all, the issue of the vaginal swab is the test that puts women in a most vulnerable test. The examination of the genitals and reproductive tract of women includes assessment of the inguinal lymph nodes and inspection and palpation of the external genitals. Completeness of the assessment of the genitals and reproductive tract depends on the needs and problems of the individual client. 1.) Examination of the genitals usually creates uncertainty and apprehension in women, and the lithotomic position required for an internal examination, used sometimes during the vaginal swab tests, can cause embarrassment, especially in the case that it is a male that is performing the test. 2.) Ignorance is also another case, whereby the women are not aware of the tests. 3.) Fear of actually having a disease. 4.) Indifference, whereby women know about the test but are not interested in carrying them out.