Prevalence of Bacterial Vaginosis in a Community Setting and Role of the Pap Smear in Its Detection

Maulana Azad Medical College, New Dilli, NCT, India
Acta cytologica (Impact Factor: 1.56). 11/2005; 49(6):634-8. DOI: 10.1159/000326251
Source: PubMed


To study the revalence of bacterial vaginosis (BV) in symptomatic and asymptomatic women in a community setting, to assess the validiy of the Pap smear in the detection of BV and to determine the sensitivity and specificity of clinical criteria for the diagnosis of BV.
Gram staining was performed on vaginal secretions collected from 301 women to determine the prevalence of BV. Each smear was assigned a score on the basis of the bacterial morphotypes identified. The bacterial pattern was also studied on 270 adequate, Pap-stained cervical smears and compared with the gold standard, the morphotypes on gram stain, to derive the validity of the Pap smear in diagnosing BV. Also each clinical criterion defined for diagnosis of BV was independently evaluated to determine their sensitivity and specificity.
The overall prevalence of BV was 41.5% in the study subjects using Amsel's and Nugent's criteria. The Pap smear was 78.3% sensitive and 86.9% specific in detection of BV. Among the clinical criteria, the presence of clue cells on wet mounts was both highly sensitive (76.7%) and specific (92.4%) for diagnosing BV, while a positive whiff test had a specificity of 86.9% with sensitivity of 33.9%. Vaginal pH > 4.5 was sensitive (88.3%) but less specific (58.6%). The presence of a thin, homogeneous discharge clinging to vaginal mucosa had low sensitivity (56.3%) and specificity (48.9%). In this study, BV was prevalent in both symptomatic and asymptomatic women. The routine Pap smear was able to detect BV in the majority of women. Its utility can be greater in asymptomatic women, in whom this infection may go undetected otherwise, resulting in future complications related to reproductive health. Among Amsel's clinical criteria, the most sensitive and specific was the presence of clue cells in wet mounts. They can be detected easily by laboratory staff with little training in primary health care seting

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    • ". Specificity for BV is 87% to 97%, with good sensitivity from 78 to 88% [16] [17] [20] [21] in most studies, but less than 57% to 59% in two others [19] [22]. Conventional Pap smears seem more accurate than liquid-based cytology for the diagnosis of BV and Trichomonas infection, but not for Candida, which is better recovered in liquid-based media [23]. "
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