A wet smear criterion for bacterial vaginosis

Abstract

Objective - To evaluate a simpler criterion for bacterial vaginosis than the recommended criterion of Amsel.

Design - Cross-sectional study comparing diagnostic data with a recommended standard.

Setting - Danish general practice.

Participants - 595 non-pregnant women aged 15-49 years who were gynaecologically examined, were divided into two groups in accordance with a complaint of vaginal discharge.

Main outcome measure - The associations of pH >4.5, homogeneity, amine odour, clue cells, and wet smear assessment of predominance of lactobacilli, Gardnerella vaginalis, motile rods with the criterion of Amsel.

Results - The four components of Amsel showed a considerable variation of association. Predominance of GV was more highly associated than several of the components. The association of a wet smear criterion composed of the presence of clue cells in combination with predominance of Gardnerella vaginalis and absence of lactobacilli was superior to other combinations. In the group without a complaint of vaginal discharge, preceding screening with use of a pH-measurement seemed advantageous.

Conclusion - The wet smear criterion seems suitable for use in general practice. But before a definitive establishment, calculation of the reproducibility of interpretation of this criterion, preferably with a more explicit setting of the components, has to be carried out.

Key Words:

• vaginal discharge
• bacterial vaginosis
• clue cells
• Gardnerella vaginalis
• lactobacilli
• wet smear criterion
• diagnostic criteria
• general practice