The diagnosis of bacterial vaginosis and vaginal flora changes.
In a population of 956 women, attending for contraceptive advice, 131 (13.7%) were found to have BV acording to Amsel's criteria. Clue cells were detected in 200 (20.9%) women, a positive amine ('sniff') test in 191 (20.0%), a vaginal pH > or = 4.7 in 243 (25.4%) and a "characteristic" vaginal discharge in 104 (10.9%) women. Sensitivity, specificity, positive and negative predictive values in relation to BV were calculated for each of these four criteria. The detection of clue cells, an increased pH and a positive sniff test showed excellent sensitivity (86-100%) values, but had a less satisfactory positive predictive value (52-68%). Vaginal discharge was found to be a poor predictor of BV. The vaginal flora in women with clue cells, increased vaginal pH or a positive sniff test was very similar to that of the women with BV, every after excluding concomitant cases of BV and the three respective criteria. Thus, a positive amine test, which is easily performed, strongly suggests BV and a vaginal flora predominated by Gardnerella vaginalis, Mycoplasma hominis, Mobiluncus species and anaerobic species on one hand, and lack of lactobacilli on the other. When there is a clinical suspicion of BV, the sniff test is positive and differential diagnoses are excluded, one can safely treat a woman for bacterial vaginosis.
Hellberg
D
D
Department of Obstetrics and Gynecology, Falun Hospital, Sweden. dan.hellberg@itdalarna.se
Nilsson
S
S
Mårdh
P A
PA
D000328:Adult; D000588:Amines / Q000032:analysis; D001421:Bacteria, Anaerobic / Q000302:isolation & purification; D002176:Candida albicans / Q000302:isolation & purification; D005260:Female; D006194:Gardnerella vaginalis / Q000302:isolation & purification; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007778:Lactobacillus / Q000302:isolation & purification; D017904:Mobiluncus / Q000302:isolation & purification; D019535:Mycoplasma hominis / Q000302:isolation & purification; D012680:Sensitivity and Specificity; D014621:Vagina / Q000382:microbiology*; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000473:pathology
D000588:Amines