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| {{CMG}}
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| {{Bacterial vaginosis}}
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| ==Overview==
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| == Diagnosis==
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| A healthcare professional seeing a woman presenting with questions about vaginal discharge and irritation in the vagina and vulva will have several diagnoses in mind to account for it. These may include:
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| *The discharge is normal for the woman
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| *[[Candidiasis]] (thrush, or a yeast infection)
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| *[[Trichomonas vaginalis]] (trichomoniasis)
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| *Bacterial vaginosis
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| To find out which of these is the case, a few simple tests are done. The healthcare provider will carry out a [[Speculum (medical)|speculum]] examination and take some swabs from high in the vagina. These swabs will be tested for:
| | {{CMG}} |
| * A characteristic smell—this is called the 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.
| | {{Bacterial vaginosis}} |
| * Loss of [[acidity]]—the vagina is normally slightly acidic (with a [[pH]] of 3.8–4.2), which helps to control bacteria. A swab of the discharge is put onto [[litmus paper]] to check the acidity. A positive result for bacterial vaginosis would be a pH of over 4.5.
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| * 'Clue cells'—so called because they give a clue to the reason behind the discharge. These are [[epithelial]] cells (like skin) that are coated with bacteria. They can be seen under microscopic examination of the discharge.
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| Two positive results in addition to the discharge itself are enough to diagnose BV. If there is no discharge, then all 3 criteria are needed.<ref name = Amsel>{{Citation | last1 = Amsel | first1 = R | last2 = Totten | first2 = PA | last3 = Spiegel | first3 = CA | last4 = Chen | first4 = KC | last5 = Eschenbach | first5 = D | last6 = Holmes| first6 = KK | year = 1983 | title = Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations | journal = Am J Med | volume = 74 | pages = 14–22}}</ref>
| | ==Physical Examination== |
| | A healthcare professional seeing a woman presenting with questions about vaginal discharge and irritation in the [[vagina]] and [[vulva]] will have several diagnoses in mind to account for it. |
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| === In clinical practice === | | ===Abdomen=== |
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| In clinical practice bacterial vaginosis (BV) is diagnosed using the Amsel criteria:<ref name = Amsel>{{Citation | last1 = Amsel | first1 = R | last2 = Totten | first2 = PA | last3 = Spiegel | first3 = CA | last4 = Chen | first4 = KC | last5 = Eschenbach | first5 = D | last6 = Holmes| first6 = KK | year = 1983 | title = Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations | journal = Am J Med | volume = 74 | pages = 14–22}}</ref>
| | ====Genitals==== |
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| # Thin, white, yellow, homogeneous discharge
| | * Fishy-odor emitted from the vagina |
| # [[Clue cells]] on [[microscopy]]
| | * Thin, white, yellow homogeneous vaginal discharge |
| # [[pH]] of vaginal fluid >4.5
| | ==References== |
| # Release of a fishy odor on adding [[alkali]]—10% [[potassium hydroxide]] (KOH) solution.
| | {{Reflist|2}} |
| | [[Category:Infectious disease]] |
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| At least three of the four criteria should be present for a confirmed diagnosis.<ref name="GCH2002">{{cite journal | author=Guideline Clearing House | title=2002 national guideline for the management of bacterial vaginosis | http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3032&nbr=2258 }}</ref>
| | [[Category:Gynecology]] |
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| An alternative is to use a Gram stained vaginal smear, with the Hay/Ison<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> criteria or the Nugent<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> criteria. The Hay/Ison criteria are defined as follows: <ref name="GCH2002">{{cite journal | author=Guideline Clearing House | title=2002 national guideline for the management of bacterial vaginosis | http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=3032&nbr=2258 }}</ref>
| | [[Category:Disease]] |
| * Grade 1 (Normal): [[Lactobacillus]] morphotypes predominate.
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| * Grade 2 (Intermediate): Mixed flora with some Lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present.
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| * Grade 3 (Bacterial Vaginosis): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent Lactobacilli. (Hay et al., 1994)
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| What this technique loses in interobserver reliability, it makes up in ease and speed of use.
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| The standard for research are the Nugent<ref name="Nugent1991">next</ref> Criteria. 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 [[Inter-observer reliability|interobserver reliability]]:
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| * 0–3 is considered negative for BV
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| * 4–6 is considered intermediate
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| * 7+ is considered indicative of BV.
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| At least 10–20 high power (1000× oil immersion) fields are counted and an average determined.
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| {| class="wikitable"
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| Lactobacillus morphotypes — '''average''' per high powered (1000× oil immersion) field. View multiple fields.
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| [[Gardnerella]] / [[Bacteroides]] morphotypes — '''average''' per high powered (1000× oil immersion) field. View multiple fields.
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| Curved Gram variable rods — '''average''' per high powered (1000× oil immersion) field. View multiple fields (note that this factor is less important — scores of only 0–2 are possible)
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| * Score 0 for >30
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| * Score 1 for 15–30
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| * Score 2 for 14
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| * Score 3 for <1 (this is an average, so results can be >0, yet <1)
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| * Score 4 for 0
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| * Score 0 for 0
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| * Score 1 for <1 (this is an average, so results can be >0, yet <1)
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| * Score 2 for 1–4
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| * Score 3 for 5–30
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| * Score 4 for >30
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| * Score 0 for 0
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| * Score 1 for <5
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| * Score 2 for 5+
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| |}
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| A recent study <ref name="pmid17078859">{{cite journal |author=Gazi H, Degerli K, Kurt O, ''et al'' |title=Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection |journal=APMIS |volume=114 |issue=11 |pages=784–7 |year=2006 |pmid=17078859 |doi=10.1111/j.1600-0463.2006.apm_485.x}}</ref> compared the gram stain using the Nugent criteria and the DNA hybridization test Affirm VPIII in diagnosing BV. The Affirm VPIII test detected Gardnerella in 107 (93.0%) of 115 vaginal specimens positive for BV diagnosed by gram stain. The Affirm VPIII test has a [[sensitivity (tests)|sensitivity]] of 87.7% and [[specificity (tests)|specificity]] of 96% and may be used for the rapid diagnosis of BV in symptomatic women.
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| ==References==
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| {{Reflist|2}}
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