Abstract
The prime purpose of this study was to define the reliability of the Pap test in establishing the diagnosis of bacterial vaginosis (BV) as well as ascertaining the trustworthiness of Pap test and Gram stain in the diagnosis of bacterial vaginosis using Amsel’s criteria as a gold standard method. Thereby prospective study conducted included 300 females attending to the Department of Gynecology and Obstetrics in our center for the usual follow-up, during a period between December 2013 and August 2014. Every patient had both Pap test and Gram-stained vaginal smear as well. Specifity, sensitivity and predictive values of aforementioned tests were calculated using the obtained results compared to Amsel’s criteria as reference values. Adopting Amsel’s criteria as a gold standard method, sensitivity and specificity of Pap test were found to be 83.4 and 95.2% respectively, compared to 93.4 and 100% in Gram stain. Whereas the positive and negative predictive values of Pap smear were estimated as 88.2 and 93%, respectively. On the other hand, Gram stain shows positive and negative predictive value of 100 and 97.2% correspondingly. Accounting on data presented in this study, it was concluded that, Pap test is found to be less sensitive for screening of BV comparable to the standard microbiological test results. Notwithstanding, it may be adequately enough owing to its high specificity. Key words: Bacteria vaginosis, Pap test, Gram stain.
Highlights
Gardner and Dukes (1955) were the first to report Haemophilus vaginalis as a cause of nonspecific vaginitis. They defined the term as, “Any woman whose ovarian activity is normal, and who has a gray, homogenous, malodorous vaginal discharge with a pH of 5.0 to 5.5 that yields no Trichomonads is likely to have H. vaginalis vaginitis.”. It is known as nonspecific vaginosis/vaginitis, so named by Blackwell and Barlow (1982), or bacterial vaginosis (BV), a term accepted by the International Agency for Research on Cancer
Of the 300 Papanicolaou test, importantly, all of them were collected from the transformation zone, it consisted of endocervical cells as well as squamous cells, notably, among the 300, there were 5 with atypical squamous cells-undetermined significant (ASC-US), 10 smears were diagnosed as LSIL and one was diagnosed as HSIL
On comparing Pap smear to Gram stain, 75 of our patients were determined as BV-positive by Pap test, compared to 84 positive cases determined by Gram stain (Tables 1 and 2)
Summary
Bacterial vaginosis (BV) is the most common cause of vaginal discharge among females of childbearing age, notably, accounting for 40 to 50% of cases (Joesoef and Schmid, 2001). Gardner and Dukes (1955) were the first to report Haemophilus vaginalis as a cause of nonspecific vaginitis They defined the term as, “Any woman whose ovarian activity is normal, and who has a gray, homogenous, malodorous vaginal discharge with a pH of 5.0 to 5.5 that yields no Trichomonads is likely to have H. vaginalis vaginitis.”. It is known as nonspecific vaginosis/vaginitis, so named by Blackwell and Barlow (1982), or bacterial vaginosis (BV), a term accepted by the International Agency for Research on Cancer. The mechanism underlying the etiology of BV suggested that “BV probably results from infection with complex communities of bacteria that consisted of metabolically interdependent species (Fredricks and Marrazzo, 2006)
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