The document discusses several methods for diagnosing bacterial vaginosis: 1. pH of discharge - an elevated pH supports but does not confirm the diagnosis. A low pH rules it out. 2. The whiff test detects a fishy odor when potassium hydroxide is added, which is highly specific. 3. A wet film exam looks for clue cells which is the most sensitive single test but requires an experienced interpreter. 4. A Gram stain examines the bacteria present and can use scoring systems to determine diagnosis. It is highly sensitive and specific.

1. DIAGNOSIS OF BACTERIAL VAGINOSIS
Prof. Aboubakr Elnashar
ABOUBAKR ELNASHAR

2. 1.pH of discharge: 5.7
A low pH virtually excludes BV. An elevated pH is the
most sensitive but least specific as an increase can
also associated with menstruation, recent sexual
intercourse, or infection with T. vaginalis
ABOUBAKR ELNASHAR

3. 2.Whiff test (amine test).
Addition of 10% KOH to a sample of vaginal
discharge: fishy odor.
PPV: 90%
specificity of 70%
ABOUBAKR ELNASHAR

4. 3.Wet film:
drop of vaginal secretion & drop of saline:
clue cells: epithelial cells covered by coccobacilli,
borders are indistinct
No WBC.
The single most sensitive & specific
operator dependent.
Debris & degenerated cells ±mistaken for clue cells
lactobacilli may adhere to epithelial cells in low
numbers.
ABOUBAKR ELNASHAR

5. 4. Gram stain:
Gr. Variable c.bacilli
no WBC
no lactobacilli
Scoring systems which weight numbers of
lactobacilli & numbers of G vaginalis & Mobiluncus.
simple & objective method.
90% sensitivity, highly sensitive & specific
cost & need for microscopist.
ABOUBAKR ELNASHAR

6. ABOUBAKR ELNASHAR

7. ABOUBAKR ELNASHAR

8. 5.Rapid tests:
.Diamine test: rapid, sensitive & specific
.Proline aminopeptidase test (Pip Activity test Card)
.A card test for detection of elevated pH &
trimethylamine (FemExam test card)
.DNA probe based test for high concentration of G.
vaginalis (Affirm VP III) may have clinical utility.
ABOUBAKR ELNASHAR

9. . Pap. smear:
clue cells. Limited clinical utility because of low
sensitivity
.Culture:
It is not recommended as a diagnostic tools
because it is not specific.
ABOUBAKR ELNASHAR

10. Amsel’s criteria
3 of the following:
.Homogenous discharge.
.pH> 4.5.
. Amine test.
.Clue cells.
Gram stain alone
corresponds well to Amsel’s criteria & to the presence
of the associated bacteria.
ABOUBAKR ELNASHAR