Diagnosis: Cytolysis caused by Lactobacilli
• The photomicrograph shows rod-shaped bacterial organisms called “lactobacilli” or “Döderlein’s bacilli,” a naked nucleus, fragments of cytoplasm from partially disintegrated intermediate squamous cells, and a single intact intermediate squamous cell.
• Lactobacillus is the most common organism comprising normal vaginal flora. They are nonencapsulated Gram-positive, rod-shaped bacteria that utilize the glycogen present in glycogen-rich intermediate squamous cells, resulting in cytolysis.
• Glycogen fermentation results in lactic acid production, contributing to the normal pH of the vagina. These organisms physiologically maintain the vaginal pH value at around 4.5.
• The principal target of Lactobacilli is glycogen-rich intermediate squamous cells; parabasal squamous cells and mature superficial squamous cells containing much less glycogen usually are spared. Lactobacilli are most numerous when intermediate cells predominate, including during pregnancy, the latter half of the menstrual cycle, progesterone containing contraceptive drugs, the premenopausal phase, and the early menopausal phase, as well as in diabetic menopausal women. They are rarely present before puberty or in atrophic postmenopausal smears.
• Staphylococcus aureus is the pathogen that has been associated with toxic shock in women using vaginal tampons.
