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Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV‐positive women

In response to the contention that use an awkward way of describing microflora “suggestive of/compatible with” BV, which indicates intrinsic insecurity about their diagnosis of BV. The terminology used in our paper “suggestive of or compatible with” BV does not indicate intrinsic insecurity about our diagnosis of BV, but rather reflects the current diagnostic terminology for cervical cytology. The diagnosis “Shift in Flora Suggestive of Bacterial Vaginosis” is recommended by the third edition of The Bethesda System for reporting cervical cytology for cases in which “individual squamous cells are covered by a layer of coccobacilli that obscure the cell membrane, forming the so-called clue cells.” The Bethesda System also states that “Large numbers of inflammatory cells indicate a vaginitis rather than a vaginosis” and that “there is a conspicuous absence of lactobacilli.” Although what exactly “large numbers” of inflammatory cells means is not specified, it is clear that the authors of The Bethesda System did not consider the presence of any inflammation as an argument against the diagnosis of bacterial vaginosis. In response to the contention that using two clue cells per high power field (HPF) (3400 magnification) does not allow to differentiate between Full blown and Partial BV, we used the criteria previously proposed by Discacciati et al., who recommended that the diagnosis of BV in Pap smears should be based on the presence of at least two clue cells per high power field (3400 magnification) after counting twenty randomly selected representative fields containing at least 10 epithelial cells per field. Discacciati et al., tested the accuracy of these standardized criteria for the diagnosis of BV in Pap smears against the most commonly used diagnostic criteria for BV, the Nugent and Amsel criteria. In Nugent’s study, a trained microbiologist analyzed Gramstained slides under 31000 magnification and bacterial morphotypes were quantified according to the Nugent score. Score of 0–3 was considered normal, score between 4 and 6 was classified intermediate, and a score >7 was considered positive for BV. The smears with an intermediate score were considered negative. Amsel’s diagnostic criteria were also evaluated by Discacciati et al. For this purpose, vaginal pH was measured during the gynecological examination, using a colorimetric pH tape that stays in contact with the vaginal wall for 1 minute. For the amine-odor (whiff) test, two drops of 10% potassium hydroxide (KOH) were added to a fraction of the sample collected from the vaginal cul-de-sac. Tests were considered positive when the characteristic fishy odor was detected. The wet-mount specimen was analyzed for the presence of clue cells under 340 magnification immediately after collection of the vaginal swab. The clinical diagnosis for BV was considered positive when at least three of the *Correspondence to: Prof Dr. Silvia Helena Rabelo-Santos, School of Pharmacy, Federal University of Goi as, Rua 240 esquina, Goiânia, Brazil. E-mail: shrabelo@ufg.br Competing interests: The authors declare no conflict of interest. Disclosure of grants or other finding: No. Received 25 July 2016; Revised 29 September 2016; Accepted 21 October 2016 DOI: 10.1002/dc.23641 Published online 1 March 2017 in Wiley Online Library (wileyonlinelibrary.com).