H. Schmidt et Jg. Hansen, Diagnosis of bacterial vaginosis by wet mount identification of bacterial morphotypes in vaginal fluid, INT J STD A, 11(3), 2000, pp. 150-155
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.