DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190297

Comparison of Amsel’s criteria and Nugent’s criteria for diagnosis of bacterial vaginosis in tertiary care centre

Romi Bansal, Priyanka Garg, Aastha Garg

Abstract


Background: Bacterial vaginosis is an imbalance in the ecology of the normal vaginal flora which is characterized by depletion of lactobacilli, and proliferation of anaerobic bacteria. It most often manifests clinically as a vaginal pH of > 4.5, presence of thin whitish homogenous vaginal discharge, detection of “clue” cells and presence of an amine odour after the addition of 10 percent potassium hydroxide. These anaerobic bacteria through specific products stimulate the decidual tissue causing an increase of cytokine level, release of phospholipase A2 and prostaglandins leading to preterm labor, premature rupture of membranes, chorioamnionitis and development of PID following abortion. To compare Amsel Criteria and Nugent Criteria for diagnosis of bacterial vaginosis.

Methods: A cross sectional study involving 260 patients with preterm and term labour was conducted at a tertiary care hospital in North India. BV was determined to be present or absent on the basis of Amsel’s criteria and Nugent’s criteria. Pearson’s chi-square test was used to demonstrate the difference between both groups with respect to various categorical data.

Results: Amsel’s criteria and Nugent’s criteria were reliable diagnostic methods. As compared to Nugent scoring system, Amsel’s criteria had sensitivity of 75%, specificity of 95%, positive predictive value of 90% and negative predictive value of 86%.

Conclusions: Although the Amsel’s criteria is a convenient and inexpensive method of diagnosing bacterial vaginosis, it is not always reliable. Nugent’s criteria is considered as a gold standard for the diagnosis of bacterial vaginosis but it requires an experienced slide reader and considerable time and skill. If lab equipment is not available as in many developing countries, the diagnosis of BV can be simplified by using a combination of any two Amsel’s criteria like vaginal pH and whiff test which had highest sensitivity and specificity (90.19% and 97.78%) respectively as seen in present study.


Keywords


Amsel’s criteria, Bacterial vaginosis (BV), Nugent’s criteria, Sensitivity, Specificity, Prevalence

Full Text:

PDF

References


Speigel CA, Amsel R, Holmes KK. Diagnosis of bacterial vaginosis by direct Gram Stain of vaginal fluid. J Clin Microbiol. 1983;18(1):170-7.

Gravett MG, Hummel D, Eschenbach DA, Holmes KK. Preterm labour associated with subclinical amniotic fluid infection with bacterial vaginosis. Obstet Gynecol.1986; 67(2):229-37.

Kurki T, Sivonen A, Renkonen OV, Savia E, Ylikorkala O. Bacterial Vaginosis in Early Pregnancy and Pregnancy Outcome. Obstet Gynecol. 1992;80(2):173–77.

Amsel R, Totten PA, Spiegel CA, Chen KCS, Eschenbach DA, Holmes KK. Nonspecific vaginitis: diagnostic criteria and microbial and epidemiological associations Am J Med. 1983; 74(1):14-22.

Nugent RP, Khrohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol. 1991;29(2):297-301.

Taj Y, Nasir D, Kahkashan N, Anjum A. Sensitivity and specificity of rapid clinical diagnostic test for BV and its analytical value. J Dow Uni Health Sci.2012;6(3);91-4.

Moussavi Z, Behrouzi R. Diagnostic Amsel criteria compared standardized method of Gram stain for the diagnosis of bacterial vaginosis. InInternational Congress Series. Elsevier 2004;1271:392-5.

Simoes JA, Discacciati MG, Brolazo EM, Portugal PM, Dini D V., Dantas MCM. Clinical diagnosis of bacterial vaginosis. Int J Gynecol Obstet. 2006;94(1):28-32.

Gutman RE, Peipert JF, Weitzen S, Blume J. Evaluation of clinical methods for diagnosing bacterial vaginosis. Obstet Gynecol 2005;105(3):551-6.

Bradshaw CS, Morton AN, Garland SM, Horvath LB, Kuzevska I, Fairley CK. Evaluation of a point-of-care test, BVBlue, and clinical and laboratory criteria for diagnosis of bacterial vaginosis. J Clin Microbiol 2005;43(3):1304-8.

Posner SF, Kerimova J, Aliyeva F, Duerr A. Strategies for diagnosis of bacterial vaginosis in a resource-poor setting. Int J STD AIDS;2005;16(1):52-5.

Mengistie Z, Woldeamanuel Y, Asrat D, Yigeremu M. Comparison of clinical and gram stain diagnosis methods of bacterial vaginosis among pregnant women in Ethiopia. J Clinic Diagnos Res: JCDR. 2013;7(12):2701.

Centers of Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm Rep 2002;51(6):42-8.

American College of Obstetricians and Gynecologists. Vaginitis. ACOG Technical Bulletin, vol. 226. Washington, DC7 American College of Obstetricians and Gynecologists; 1996.