Acta Cytol. 2005 Nov-Dec;49(6):634-8
Prevalence of bacterial vaginosis in a community setting and role of the pap smear in its detection.
Division of Cytopathology, Institute of Cytology and Preventive Oncology, I
Ndia. To study the relevence of bacterial vaginosis (BV) in symptomatic and
asymptomatic women in a community setting, to assess the validity 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 settingObjectives:
Study Design:
Results:
