Abstract
BackgroundThe most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV). Amsel’s criteria and Nugent scoring systems are commonly employed approaches for the diagnosis of BV. Despite the Nugent scoring system being the gold standard method for diagnosing BV, Amsel’s criteria are generally preferred in clinical setup owing to the fact Nugent scoring requires considerable time and expert microscopist. This study was conducted to determine the diagnostic value of Amsel’s criteria by comparing it with the Nugent scoring system.MethodsThis was a descriptive cross-sectional study conducted at Tribhuvan University Teaching Hospital, Nepal from October 2016 to September 2017. Vaginal specimens were collected from a total of 141 women presenting with abnormal vaginal discharge. The sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were calculated, and each component of Amsel’s criteria was compared to the Nugent scoring system.ResultsThe sensitivity, specificity, positive predictive value, and negative predictive value of Amsel’s criteria were 50%, 98.2%, 87.5%, and 88.8% respectively. The clue cells showed 100% specificity and vaginal discharge with pH > 4.5 had 89.3% sensitivity while compared with Nugent’s scoring system.ConclusionsAmsel’s criteria can be used as an adjunct method to Nugent scoring for the diagnosis of BV in the hands of skilled manpower in resources limited countries. The presence of clue cell and positive whiff test of Amsel’s criteria shows good match with Nugent’s score.
Highlights
The most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV)
The present study revealed maximum BV cases belonging to the age group 25–34 years followed by 15–24 years
Our study showed that the presence of clue cells and the positive whiff test were highly suggestive of BV (P < 0.001) (Table 4)
Summary
The most common pathological cause of abnormal vaginal discharge in reproductive-aged women is bacterial vaginosis (BV). This study was conducted to determine the diagnostic value of Amsel’s criteria by comparing it with the Nugent scoring system. In a reproductive age group woman, the healthy vagina should have an abundance of Gram-positive rods, usually Lactobacillus spp, a low pH (≤ 4.5), and the absence of both facultative and obligatory anaerobic Gram-negative bacilli [1]. The prevalence of BV in developing countries ranges from 20 to 47% among non-pregnant women [4] which depends on geographical location, socio-economic status, and ethnicity [5]. In Nepal, few studies have been conducted about BV but there are no published reports on the diagnostic value of Amsel’s criteria for the diagnosis of BV. Manandhar et al [7] and Bhargava et al [8] have found 2.5 and 54.3% BV cases among non-pregnant Nepalese women
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