gynecology and obstetrics
Bacterial Vaginosis (BV)
Diagnosis of Bacterial Vaginosis
Pelvic examination Vaginal pH and microscopy If microscopy is unavailable, sometimes nucleic acid amplification tests (NAATs) For bacterial vaginosis to be diagnosed, 3 of 4 criteria (Amsel criteria) must be present: Yellow-green or gray discharge Vaginal secretion pH > 4.5 Fishy odor on the whiff test (application of potassium hydroxide) Clue cells on saline (0.9%) wet mount Clue cells (bacteria adhering to epithelial cells and sometimes obscuring their cell margins) are identified by microscopic examination of a saline wet mount. Presence of white blood cells on a saline wet mount suggests a concomitant infection (possibly trichomonal, gonorrheal, or chlamydial Cervicitis ) and the need for additional testing. NAATs are commercially available for clinical use ( Diagnosis references ). If microscopy is unavailable, the diagnosis is inconclusive, or the patient remains symptomatic, a NAAT should be considered. 1.Cartwright CP, Lembke BD, Ramachandran K, et al: Development and validation of a semiquantitative, multitarget PCR assay for diagnosis of bacterial vaginosis.J Clin Microbiol50 (7):2321–2329, 2012. doi: 10.1128/JCM.00506-12 2.Schwebke JR, Gaydos CA, Nyirjesy P, et al: Diagnostic performance of a molecular test versus clinician assessment of vaginitis.J Clin Microbiol56 (6):e00252-18, 2018. doi: 10.1128/JCM.00252-18 3.Gaydos CA, Beqaj S, Schwebke JR, et al: Clinical validation of a test for the diagnosis of vaginitis.Obstet Gynecol130 (1):181–189, 2017. doi: 10.1097/AOG.0000000000002090 4.Coleman JS, Gaydos CA: Molecular diagnosis of bacterial vaginosis: An update.J Clin Microbiol56 (9):e00342–e00318, 2018. doi: 10.1128/JCM.00342-18 