Correlation between clinical criteria and laboratory criteria as diagnostic for bacterial vaginosis

Abstract

Bacterial vaginosis may be defined either by clinical or microbiological variables. Amsers criteria allow for the diagnosis of bacterial vaginosis when three out of the following four criteria are detected. 1). Vaginal pH > 4.5: 2); Positive amine test with KOH 10%.3); Presence of clue cells: 4) Presence of a white. thin and homogeneous vaginal discharge This work's objective was to compare Amsel’s criteria efficiency against Nugent's gradient on bacterial vaginosis diagnosis. Evaluation was performed on 100 samples of patients with signs and clinical symptoms of vaginal infection between September of 1999 and October of 2000 at the gynecology and obstetrics unit of the "Hospital de Clínicas". The patients were submitted to gynecological examinations in order to verify the mucous appearance and vaginal fluids. Samples were collected to measure the vaginal pH, perform the amine test, wet mount and stain Gram. The Nugent's gradient was determined and compared to the Amsel’s criteria for the characterization of the bacterial vaginosis. The incidence of bacterial vaginosis among the studied subjects was 34% for the laboratorial criteria and 14% for the clinical criteria. There was no meaningful concordance (Kappa = 0,47) between Amsel's criteria and the Nugent gradient. This conclusion leads to a necessity for a discussion about the medical gynecological routine, which characterizes bacterial vaginosis only through clinical signs.