Bacterial vaginosis laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref> | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
In clinical practice, the diagnosis of bacterial vaginosis is based on the presence of at least three [[Amsel criteria bacterial vaginosis|Amsel criteria]]. | In clinical practice, the diagnosis of bacterial vaginosis is based on the presence of at least three [[Amsel criteria bacterial vaginosis|Amsel criteria]].<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref | ||
Usually vginal swabs following [[Speculum (medical)|speculum]] examination will be tested for: | Usually vginal swabs following [[Speculum (medical)|speculum]] examination will be tested for: | ||
*Whiff test: A small amount of an alkali is added to a [[microscope slide]] that has been swabbed with the discharge—a 'fishy' odour is a positive result for bacterial vaginosis. | *Whiff test: A small amount of an alkali is added to a [[microscope slide]] that has been swabbed with the discharge—a 'fishy' odour is a positive result for bacterial vaginosis. | ||
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===Gram Satin=== | ===Gram Satin=== | ||
Gold standard for diagnosis of bacterial vaginosis is a Garm stain of vaginal discharge.<ref name="pmid1706728">{{cite journal| author=Nugent RP, Krohn MA, Hillier SL| title=Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. | journal=J Clin Microbiol | year= 1991 | volume= 29 | issue= 2 | pages= 297-301 | pmid=1706728 | doi= | pmc=269757 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1706728 }} </ref> Gram staining is usually reserved for research studies and can be used with the Hay/Ison criteria or the Nugent criteria. | Gold standard for diagnosis of bacterial vaginosis is a Garm stain of vaginal discharge.<ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref<ref name="pmid1706728">{{cite journal| author=Nugent RP, Krohn MA, Hillier SL| title=Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. | journal=J Clin Microbiol | year= 1991 | volume= 29 | issue= 2 | pages= 297-301 | pmid=1706728 | doi= | pmc=269757 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1706728 }} </ref> Gram staining is usually reserved for research studies and can be used with the Hay/Ison criteria or the Nugent criteria. | ||
====Other Diagnostic Criteria==== | ====Other Diagnostic Criteria==== | ||
An alternative is to use a Gram stained vaginal smear, with the Hay/Ison criteria or the Nugent criteria.<ref name = HayIson>{{Citation | last1 = Ison | first1 = CA | last2 = Hay | first2 = PE | year = 2002 | title = Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics | journal = Sex Transm Infect | volume = 78 | pages = 413–415}}</ref><ref name="Nugent1991">{{cite journal |author=Nugent, R. P., M. A. Krohn, and S. L. Hillier | title=Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation | journal=J. Clin. Microbiol | year=1991 | volume=29 | pages=297–301 }}</ref> | An alternative is to use a Gram stained vaginal smear, with the Hay/Ison criteria or the Nugent criteria.<ref name = HayIson>{{Citation | last1 = Ison | first1 = CA | last2 = Hay | first2 = PE | year = 2002 | title = Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics | journal = Sex Transm Infect | volume = 78 | pages = 413–415}}</ref><ref name="Nugent1991">{{cite journal |author=Nugent, R. P., M. A. Krohn, and S. L. Hillier | title=Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation | journal=J. Clin. Microbiol | year=1991 | volume=29 | pages=297–301 }}</ref> | ||
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The Papanicolaou smear is not reliable for diagnosis of bacterial vaginosis.<ref name="pmid10819823">{{cite journal| author=Greene JF, Kuehl TJ, Allen SR| title=The papanicolaou smear: inadequate screening test for bacterial vaginosis during pregnancy. | journal=Am J Obstet Gynecol | year= 2000 | volume= 182 | issue= 5 | pages= 1048-9 | pmid=10819823 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10819823 }} </ref> | The Papanicolaou smear is not reliable for diagnosis of bacterial vaginosis.<ref name="pmid10819823">{{cite journal| author=Greene JF, Kuehl TJ, Allen SR| title=The papanicolaou smear: inadequate screening test for bacterial vaginosis during pregnancy. | journal=Am J Obstet Gynecol | year= 2000 | volume= 182 | issue= 5 | pages= 1048-9 | pmid=10819823 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10819823 }} </ref> | ||
===Culture=== | ===Culture=== | ||
Vaginal culture has no role in diagnosis of bacterial vaginosis.<ref name="pmid27428605">{{cite journal| author=Stockdale CK| title=A Positive Culture Result for Gardnerella Is Not Diagnostic of Bacterial Vaginosis. | journal=J Low Genit Tract Dis | year= 2016 | volume= 20 | issue= 4 | pages= 281-2 | pmid=27428605 | doi=10.1097/LGT.0000000000000237 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27428605 }} </ref> | Vaginal culture has no role in diagnosis of bacterial vaginosis. <ref name=CDC_MMWR-2015>Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016</ref<ref name="pmid27428605">{{cite journal| author=Stockdale CK| title=A Positive Culture Result for Gardnerella Is Not Diagnostic of Bacterial Vaginosis. | journal=J Low Genit Tract Dis | year= 2016 | volume= 20 | issue= 4 | pages= 281-2 | pmid=27428605 | doi=10.1097/LGT.0000000000000237 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27428605 }} </ref> | ||
==References== | ==References== | ||
Revision as of 15:53, 20 October 2016
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Laboratory Findings
In clinical practice, the diagnosis of bacterial vaginosis is based on the presence of at least three Amsel criteria.Closing </ref> missing for <ref> tag Gram staining is usually reserved for research studies and can be used with the Hay/Ison criteria or the Nugent criteria.
Other Diagnostic Criteria
An alternative is to use a Gram stained vaginal smear, with the Hay/Ison criteria or the Nugent criteria.[2][3]
Hay/Ison Criteria
The Hay/Ison criteria are defined as follows: [4]
| Grading | Definition |
|---|---|
| Grade 0 | No bacteria present |
| Grade 1 | Lactobacillus morphotypes predominate |
| Garde 2 | Mixed flora with (some lactobacilli, gardnerella,or mobiluncus morphotypes present) |
| Garde 3 | Predominantly gardnerella and/or mobiluncus morphotypes (few or absent lactobacilli) |
| Garde 4 | Gram-positive cocci predominate |
- Grade 3 is diagnostic
Nugent Criteria The standard for research are the Nugent Criteria.[3]
| Score | 0 | 1 | 2 | 3 | 4 |
|---|---|---|---|---|---|
| Lactobacillus morphotypes | >30 | 15-30 | <14 | <1 (this is an average) | 0 |
| Gardnerella/Bacteroides morphotypes | 0 | <1 (this is an average) | 1-4 | 5-30 | >30 |
| Curved Gram variable rods | 0 | <5 | >5 |
In this scale a score of 0-10 is generated from combining three other scores. It is time consuming and requires trained staff but is has high interobserver reliability:
- 0–3 is considered negative for bacterial vaginosis
- 4–6 is considered intermediate
- 7+ is considered indicative of bacterial vaginosis
Cytology
The Papanicolaou smear is not reliable for diagnosis of bacterial vaginosis.[5]
Culture
Vaginal culture has no role in diagnosis of bacterial vaginosis. Closing </ref> missing for <ref> tag
References
- ↑ Center for Disease Control and prevention. Mortality and morbidity weekly reports. Sexually transmitted disease treatment guideline. (2015) https://www.cdc.gov/std/tg2015/tg-2015-print.pdf Accessed on October 20, 2016
- ↑ Ison, CA; Hay, PE (2002), "Validation of a simplified grading of Gram stained vaginal smears for use in genitourinary medicine clinics", Sex Transm Infect, 78: 413–415
- ↑ 3.0 3.1 Nugent, R. P., M. A. Krohn, and S. L. Hillier (1991). "Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation". J. Clin. Microbiol. 29: 297&ndash, 301.
- ↑ Guideline Clearing House. "2002 national guideline for the management of bacterial vaginosis". Unknown parameter
|http://www.guideline.gov/summary/summary.aspx?ss=ignored (help) - ↑ Greene JF, Kuehl TJ, Allen SR (2000). "The papanicolaou smear: inadequate screening test for bacterial vaginosis during pregnancy". Am J Obstet Gynecol. 182 (5): 1048–9. PMID 10819823.