Aerobic Vaginitis Diagnosis Criteria Combining Gram Stain with Clinical Features: An Establishment and Prospective Validation Study

Abstract

Wet-mount microscopy aerobic vaginitis (AV) diagnostic criteria need phase-contrast microscopy and keen microscopists, and the preservation of saline smears is less common in clinical practice. This research work developed new AV diagnostic criteria that combine Gram stain with clinical features. We enrolled 325 AV patients and 325 controls as a study population to develop new AV diagnostic criteria. Then, an independent group, which included 500 women, was used as a validation population. AV-related microscopic findings on Gram-stained and wet-mount smears from the same participants were compared. The accuracy of bacterial indicators from the two methods was verified by bacterial 16S rRNA V4 sequencing (n = 240). Logistic regression was used to analyse AV-related clinical features. The screened clinical features were combined with Gram-stain microscopic indicators to establish new AV diagnostic criteria. There were no significant differences in the leukocyte counts or the parabasal epitheliocytes (PBC) proportion between the Gram-stain and wet-mount methods (400×). Gram stain (1000×) satisfied the ability to identify bacteria as verified by 16S rRNA sequencing but failed to identify toxic leukocytes. The new criteria included: Lactobacillary grades (LBG) and background flora (Gram stain, 1000×), leukocytes count and PBC proportion (Gram stain, 400×), and clinical features (vaginal pH > 4.5, vagina hyperemia, and yellow discharge). These criteria satisfied the accuracy and reliability for AV diagnosis (Se = 86.79%, Sp = 95.97%, and Kendall’s W value = 0.899) in perspective validation. In summary, we proposed an alternative and valuable AV diagnostic criteria based on the Gram stain, which can make it possible to diagnose common vaginitis like AV, BV, VVC, and mixed infections on the same smear and can be available for artificial intelligence diagnosis in the future.

Cracking the Code: Investigating the Correlation between Aerobic Vaginitis and Preterm Labor

“…The diagnosis of AV relies on wet mount microscopy, performed by a phase-contrast microscope, in order to assess lactobacillus grades and other variables, such as leukocytes, the percentage of toxic leukocytes and parabasal epithelial cells, and the type of background flora. All the parameters mentioned above serve as parts of a composite score that leads to the final diagnosis [1,20].…”

Cracking the Code: Investigating the Correlation between Aerobic Vaginitis and Preterm Labor

“…Diagnosis of AV relies on wet mount microscopy, performed by a phase-contrast microscope, in order to assess lactobacillus grades and other variables, such as leukocytes, the percentage of toxic leukocytes and parabasal epithelial cells, and the type of background flora. All the parameters mentioned above serve as parts of a composite score that directs to the final diagnosis [1,20].…”

Microbial Diversity and Pathogenic Properties of Microbiota Associated with Aerobic Vaginitis in Women with Recurrent Pregnancy Loss

“…In the current study we focused on AV, and smears were analyzed using Donders’ classification method and Dong’s modified AV diagnosis for Gram stains. [ 17 , 30 ] ‘Any AV’ was defined as an AV score of 4 or more, with a subclassification of ‘light AV’ if the score was 4–5, ‘moderate AV’ if it was between 6–7, and ‘severe AV’ when it was 8–10.…”