Validity of the Vaginal Gram Stain for the Diagnosis of... : Obstetrics & Gynecology (original) (raw)

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Validity of the Vaginal Gram Stain for the Diagnosis of Bacterial Vaginosis

SCHWEBKE, JANE R. MD; HILLIER, SHARON L. PhD; SOBEL, JACK D. MD; McGREGOR, JAMES A. MD, CM; SWEET, RICHARD L. MD

Department of Medicine, University of Alabama at Birmingham, Birmirrgham, Alabama; the Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, and Magee-Women's Research Institute, Pittsburgh, Pennsylvania; the Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan; and the Department of Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado.

Address reprint requests to: Jane R. Schwebke, MD, Division of Infectious Diseases, University of Alabama at Birmingham School of Medicine,1900 University Blvd. 1229 Harrison Tower, Birmingham, AL 35294-0006.

Support for this project was provided by Litmus Concepts Inc., Santa Clara, California, and by the Sexually Transmitted Diseases Cooperative Research Centers (NIH AI-94-16)

Financial Disclosure Each of the authors has served as a consultant to various drug companies that market medications to treat bacterial vaginosis and/or has received honoraria and/or research grants from such companies.

Received February 20, 1996. Received in revised form June 3, 1996. Accepted June 7, 1996.

Objective

To determine the sensitivity and specificity of vaginal Gram stain as interpreted by the Nugent criteria for the diagnosis of bacterial vaginosis, and to consider the use of Gram stain as the criterion standard for the diagnosis of bacterial vaginosis.

Methods

A multicenter study was conducted of women attending gynecology or sexually transmitted disease clinics. Clinical data consisting of vaginal pH, “whiff test,” clue cells, and appearance of the vaginal discharge (Amsel criteria) were compared with the vaginal fluid Gram stain (Nugent criteria) for the diagnosis of bacterial vaginosis.

Results

The sensitivity and specificity of the Gram stain compared with the Amsel criteria were 89 and 83%, respectively. There was significant variation in the specificity values by geographic site. If the Gram stain was considered the criterion standard for the diagnosis of bacterial vaginosis, the sensitivity and specificity of the Amsel criteria were 70 and 94%, respectively.

Conclusion

The vaginal Gram stain (Nugent criteria) is a sensitive method for the diagnosis of bacterial vaginosis. The 83% specificity suggests that the currently used Amsel criteria may lead to the underdiagnosis of bacterial vaginosis.