Development of modified diagnostic criteria for bacterial vaginosis at peripheral health centres in developing countries

Abstract

Introduction: Bacterial vaginosis (BV) is the commonest cause of abnormal vaginal discharge in women of child-bearing age and is associated with increased susceptibility to HIV-AIDS and sexually transmitted diseases. In obstetrics, BV has been implicated in causing various complications. In clinical practice, BV is diagnosed using Amsel criteria and Nugent scoring. Using modified Amsel criteria, we determined that the fulfilling of any two instead of three criteria can be diagnostic of BV. Methodology: This prospective cross-sectional study involved pregnant females complaining of excessive vaginal discharge admitted in a tertiary health centre in central India. Four vaginal swabs were collected for the diagnosis of BV by Amsel criteria, modified Amsel criteria, and Nugent scoring on Gram stain. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of each individual criterion and combinations of criteria were calculated by using Nugent scoring as the gold standard and by chi square test. Results: In the present study overall prevalence of BV was 12%. The sensitivity of individual or a combination of two criteria was almost same or higher than that of Amsel criteria. Specificity of each combination of criteria was comparable to that of Amsel criteria. However, a combination of high pH and amine odor test had the highest sensitivity (88%) and highest PPV (62%). Diagnostic accuracy of all combinations in our study was equal to or slightly higher than that of Amsel criteria. Conclusion: Diagnostic accuracy of new modified Amsel criteria is as reliable as that of Amsel criteria.

Comparison of Clinical and Gram Stain Diagnosis Methods of Bacterial Vaginosis Among Pregnant Women in Ethiopia

“…This result is similar with the finding by Mastrobattista and his colleagues [14]. Many studies suggested that raised vaginal pH is recognized as the least specific criteria [14,19] and it is confirmed in our investigation. The lower specificity and positive predictive value of vaginal pH compared to others clinical criteria in this study indicates the presence of other genital tract infection or factor which increases pH without the presence of disturbed vaginal flora.…”

“…It had a higher sensitivity, specificity and positive and negative predictive value. This is consistent with the study done by other researcher's [16][17][18][19]. But this is not consistent with Dadhwal et al, [11].…”

“…The combination of two criteria had sensitivity of 61.2% to 77.6%, specificity of 99% to 100%. Amine test plus pH as diagnosis of clinical test is mostly recommended among the study done in different setting, population and countries [11,13,19]. In contrast to these three studies, we found that combination of clue cells and pH had the highest sensitivity and very good specificity than pH and amine test.…”

Risk Factors for Preterm Birth and Low Birth Weight Among Pregnant Indian Women: A Hospital-based Prospective Study

“…In particular, the causal relationship between BV and PTB among women from various ethnic groups has been consistently noted. A few studies have reported the magnitude of BV during pregnancy among Indian women (6.4% [ 17 ], 24.3% [ 18 ], and 12% [ 19 ]); however, the paucity of data regarding the potential association of BV with PTB among these women is evident in the published literature. A lower rate of BV (6%) could possibly be attributed to the socioeconomic and lifestyle factors of our study population.…”

A blinded, randomized controlled trial of high-dose vitamin D supplementation to reduce recurrence of bacterial vaginosis

“…Some studies demonstrate that BV diagnosis using only two Amsel criteria (vs. four) has similar sensitivity and specificity compared to Nugent scoring. 28–29 Other studies indicate that the sensitivity of Amsel criteria can be low compared with Nugent scoring. 30–31 In this study, the variability in the two diagnostic methods was clearly demonstrated: all women had symptomatic BV at enrollment by modified Amsel criteria, but only 80% had BV according to Nugent scoring.…”