CLINICAL CORRELATION AND LABORATORY DIAGNOSIS OF BACTERIAL VAGINOSIS

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 CLINICAL CORRELATION AND LABORATORY DIAGNOSIS OF BACTERIAL VAGINOSIS

Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2016, Vol 5, Issue 60

Abstract

 Bacterial vaginosis characterised by a heavy overgrowth of gram-negative and gram-positive anaerobes with no signs of inflammation has been regarded as a microbiological and immunological enigma. AIMS AND OBJECTIVES 1. To identify the causative organisms from clinically suspected cases of bacterial vaginosis. 2. To evaluate the accuracy of Amsel’s clinical criteria and Nugent’s Gram stain criteria for diagnosis of bacterial vaginosis. 3. To correlate with other associated sexually transmitted infections. MATERIAL AND METHODS This prospective study involving total 600 non-pregnant women with abnormal vaginal discharge, clinically suspected cases of bacterial vaginosis (BV) attending the Gynaecology OPD at a tertiary care hospital was done over a period of one year. The following samples were collected from each subject: Three vaginal swabs and one blood sample (5 mL). Three vaginal swabs were taken and immediately sent to the microbiology laboratory for processing, by microscopy and culture on appropriate media. For serological diagnosis of Hepatitis B and C, HIV, and VDRL testing, 5 mL blood was collected from cubital vein with aseptic precautions. The following parameters were noted - age, marital status, contraceptive use, presence of abnormal, recurrent, and/or foul-smelling vaginal discharge and clue cells. BV was diagnosed using Amsel’s clinical criteria and Nugent’s Gram stain criteria. Data was analysed using SPSS version 13, Fischer’s exact test, and chi-square test. RESULTS BV occurred in 142/600 (23.7%) women with abnormal vaginal discharge, 55/135 (40.7%) were in age group 36-45 yrs., 140/593 (23.6%) married women and in 92/259 (35.5%) women with recurrent vaginal discharge. Abnormal discharge was most commonly seen (193/600) women who had not used any contraceptives. Foul-smelling discharge was more in BV patients as compared to pain, itching, and burning micturition, which was more common in non-bacterial vaginosis (NBV) and had statistically significant p value (<0.05). Clue cells were seen in total 19/142 (13.3%) patients suffering from BV. Based on Nugent’s score, the 600 cases were classified as normal (223), intermediate (161), and BV (142). Based on aetiology, it was noted that mixed infection occurred in 42/600 cases: Vulvovaginal candidiasis (VVC) + intermediate in 24, BV+VVC in 16, and BV+Trichomoniasis in 2. Majority of anaerobes, i.e. 100/136 (73.5%) were found in BV patients. This association of anaerobes in BV was found to be significant with p-value (<0.05). Yeast was grown in 105/600 (17.5%); 16/105 (11.3%) were significantly associated with BV (p<0.05). CONCLUSION The Gram stain as interpreted by Nugent’s criteria provides an objective, reproducible laboratory based test, and should be used in addition to clinical criteria for diagnosis of BV.

Authors and Affiliations

Kirti , Kumar , Jayanthi

Keywords

Bacterial Vaginosis (BV).

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EP ID EP118166
DOI 10.14260/jemds/2016/948
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