Diagnosis of bacterial vaginosis by wet mount identification of bacterial morphotypes in vaginal fluid

In order to develop a more practical way of diagnosing bacterial vaginosis (BV), we evaluated a scoring system, weighting small bacterial morphotypes versus lactobacillary morphotypes in wet mounts, assessed criteria for BV a nd normalcy from this scoring, and then evaluated their reproducibility and accuracy. We examined 751 women for pH, homogeneous vaginal discharge, ami ne odour, clue cells and the composite clinical diagnosis. We also examined wet mounts for small bacterial morphotypes and lactobacillary morphotypes, and weighted their quantitative presence as a bacterial morphotype score. The term 'small bacterial morphotypes denotes a group of small bacillary fo rms comprising coccobacilli, tiny rods, and mobile curved rods. The differe nt characteristics of BV were all gradually associated with increased bacte rial morphotype scoring. We deemed a scorn of 0-1 as normal, 23 as intermed iate phase, grade I, 5-6 as intermediate phase, grade II, and 7-8 indicativ e of BV. Reproducibility of the interpretation was high, both for the new g rading system (weighted Kappa 0.90 in women perceiving and 0.81 in women no t perceiving abnormal vaginal discharge) and for the new criterion for BV ( non-weighted Kappa 0.91 and 0.84 in the 2 groups of women). The new criteri on also proved highly concurrent with the composite clinical diagnosis (Kap pa 0.91 anal 0.81 in the 2 groups). In conclusion, the wet mount bacterial morphotype scoring is valid for grading of the disorder of the vaginal micr obial ecosystem, and the ne tv criterion fur BV a more practical option tha n existing diagnostic methods.