COMPARISON OF GRAM-STAINED SMEARS PREPARED FROM BLIND VAGINAL SWABS WITH THOSE OBTAINED AT SPECULUM EXAMINATION FOR THE ASSESSMENT OF VAGINAL FLORA

Objective To determine whether Gram-stained smears obtained from blind vaginal swabs could be used reliably for the assessment of the vagina l flora. Design A prospective, blind comparative study. Setting The an tenatal clinic of a district general hospital. Participants Eighty-eig ht women examined and screened for the presence of bacterial vaginosis during their first antenatal clinic visit. Two smears were obtained f or each woman, the first prepared from a vaginal swab taken blindly an d the second at speculum examination. The smears were Gram-stained and classified according to the Nugent score: Grade 1 (normal), Grade 2 ( intermediate), Grade 3 (bacterial vaginosis). Results Eight of the 88 pregnant women were identified as having bacterial vaginosis on the ba sis of the smear taken at speculum examination, and these were correct ly identified as having bacterial vaginosis by smears prepared from th e blindly taken swab. This gives the blind vaginal swab technique for detecting bacterial vaginosis a sensitivity and specificity of 100% wh en compared with swabbing at speculum examination. The flora of two wo men were graded as intermediate, and of 75 as normal by both technique s. Only in three cases was there a disparity between the two technique s, a difference that was not statistically significant (kappa = 0.8546 , 95% CI 0.6945 to 1.0). Conclusions Vaginal smears prepared from corr ectly taken blind vaginal swabs can be used to assess the vaginal flor a and screen for bacterial vaginosis. This method could be used in epi demiological studies of bacterial vaginosis in the general population and for screening antenatal populations for abnormal vaginal flora.