Lab test results are often marked with (+) and (–). These symbols do not represent mathematical addition or subtraction; they stand for positive and negative results respectively. Many people confuse their meanings, so here is a step-by-step guide to interpretation.

Understanding BV Tests and Cervical Pap Smears

Core routine gynecological tests include routine vaginal discharge analysis, BV test and cervical Pap smear.

1. Routine Vaginal Discharge Test

Vaginal cleanliness is graded I to IV. Grades I and II are normal; Grade III or above suggests possible vaginitis or cervicitis, to be judged together with other indicators:

- Positive trichomonas: trichomonal vaginitis

- Positive fungi (mold): candidal vaginitis

Both require standardized full-course treatment, including treatment for sexual partners.

2. BV (Bacterial Vaginosis)

A common mixed infection caused by disrupted normal vaginal flora, dominated by anaerobes, distinct from ordinary vaginitis.

3. Cervical Pap Smear

A key screening tool for early cervical cancer, also known as a cancer-prevention smear. Two reporting systems are used: grading diagnosis and descriptive diagnosis. Most domestic hospitals still adopt the Papanicolaou grading system:

- Pap Class I: Normal

- Pap Class II: Inflammation; mild nuclear atypia without malignant signs (subdivided into IIA)

- Pap Class III: Suspicious malignant cells

- Pap Class IV: Highly suspicious malignant cells

- Pap Class V: Confirmed cancer

The five-grade Pap system relies heavily on subjective judgment without strict objective cutoffs, so it is gradually replaced by the TBS classification system (which requires professional physicians to interpret). Many hospitals use electronic colposcopy to magnify the cervix 10–40 times, stain suspicious lesions and target sampling to boost detection rates.

How to Interpret Vaginal Discharge Reports

Vaginal discharge is a mixture of vaginal mucosal exudate, cervical gland and endometrial secretions, regulated by estrogen. A standard routine discharge test covers six items:

1. pH Value

Ovarian hormones after puberty make vaginal epithelial cells rich in glycogen, which lactobacilli break down into lactic acid, creating a weakly acidic environment for self-cleaning and pathogen inhibition. Normal pH = 4.5. Trichomonal or bacterial vaginosis raises pH above 5–6.

2. Vaginal Cleanliness (4 Grades)

- Grade I: Massive vaginal epithelial cells and lactobacilli under microscope

- Grade II: Epithelial cells, a small number of white blood cells, partial lactobacilli, few miscellaneous bacteria/pus cells

- Grade III: Sparse lactobacilli, abundant pus cells and miscellaneous bacteria

- Grade IV: No lactobacilli visible; mainly pus cells and miscellaneous bacteria with minimal epithelial cells

Grades I–II = normal; III–IV = abnormal, indicating vaginitis.

3. Mold & Trichomonas

Trichomonas or fungi are marked “+” once detected, regardless of quantity. The symbol only confirms infection severity cannot be judged by the number of plus signs.

4. Amine Test

Discharge with bacterial vaginosis has a fishy odor, released when amines in secretions are alkalinized with potassium hydroxide.

5. Clue Cells

Epithelial cells covered by masses of bacteria, with blurred granular or dotted cell margins on wet-mount slides. Clue cells are the most sensitive and specific marker for bacterial vaginosis. A positive amine test plus visible clue cells confirms the diagnosis.

How to Read Urinalysis Reports

Urinalysis assesses urine color, clarity, pH, specific gravity, protein, glucose and midstream urinary sediment.

- (+), (++), (+++): Positive results (higher plus signs mean higher concentration)

- (–): Negative result

Positive markers usually signal urinary system disorders.

- Abundant white blood cells (WBC ++ ~ +++) and epithelial cells: Urinary tract infection

- Numerous red blood cells (RBC + ~ +++): Kidney stones, tumors, acute nephritis, cystitis or urinary trauma

- Positive casts: Renal damage, seen in acute/chronic nephritis, pyelonephritis, nephrotic syndrome

- Positive urine glucose: Highly suggestive of diabetes. Normal urine contains only trace undetectable glucose; transient glycosuria may occur after heavy sugar intake or intravenous glucose. Diabetics show both positive urine glucose and significantly elevated blood glucose.