Abstract
ObjectiveClue cells characteristic of bacterial vaginosis (BV) are thought to arise due to exfoliation of the vaginal epithelium; however, there is little published data connecting total numbers of epithelial cells to markers of BV. The purpose of this study was to enumerate exfoliated epithelial cells (independent of clue cells) and examine the relationship to Nugent score.Study designWe conducted a cross-sectional sub-study of the Contraceptive CHOICE Project cohort. Vaginal swabs were used to create vaginal smears for Gram staining and these smears were later scored using the Nugent method, and then two blinded observers used microscopy to enumerate exfoliated epithelial cells. The degree of epithelial cell exfoliation was compared between women diagnosed as BV-negative (Nugent score 0–3), BV-intermediate (Nugent score 4–6), and BV-positive (Nugent score 7–10). BV specimens (Nugent 7–10) were randomly matched to specimens in the two other groups (Nugent low and Nugent-intermediate), in order to avoid comparing groups of women with potentially confounding baseline demographics.ResultsExfoliated epithelial cell counts were higher in the vaginal smears from BV-positive women compared with BV-negative women. Higher levels of epithelial exfoliation were also evident in BV-intermediate women compared to those with low Nugent scores. After adjustment for clustering introduced by matching, the incidence ratio of increased epithelial cell counts was 2.09 (95% CI 1.50–2.90) for the BV-intermediate women and 1.71 (95% CI 1.23–2.38) for the BV positive women.ConclusionA vaginal epithelial exfoliation phenotype was measured in both Nugent-defined BV-positive and BV-intermediate women. Bacterial vaginosis and intermediate status (Nugent score >3) was associated with significantly more vaginal epithelial exfoliation compared to women with Lactobacillus-dominated microbiotas (Nugent 0–3).
Highlights
The healthy human vagina is host to a Lactobacillus-dominated microbiota, which appears to have a critical role in thwarting colonization or infection by bacteria, viruses, and parasites that have been linked with negative health outcomes [1]
Exfoliated epithelial cell counts were higher in the vaginal smears from bacterial vaginosis (BV)-positive women compared with BV-negative women
After adjustment for clustering introduced by matching, the incidence ratio of increased epithelial cell counts was 2.09 for the BV-intermediate women and 1.71 for the BV positive women
Summary
The healthy human vagina is host to a Lactobacillus-dominated microbiota, which appears to have a critical role in thwarting colonization or infection by bacteria, viruses, and parasites that have been linked with negative health outcomes [1]. The gold standard for laboratorybased BV diagnosis is the Nugent scoring method [14] By this method, Gram stained smears of vaginal fluid are quantified for the presence of Gram positive ‘beneficial’ Lactobacillus morphotypes as compared to Gram negative organisms and Gram variable Actinobacteria such as Gardnerella, Atopobium and Mobiluncus. Gram stained smears of vaginal fluid are quantified for the presence of Gram positive ‘beneficial’ Lactobacillus morphotypes as compared to Gram negative organisms and Gram variable Actinobacteria such as Gardnerella, Atopobium and Mobiluncus This approach results in an overall score in which 0–3 indicates a “normal” lactobacilli-dominated microbiota, 7–10 indicates BV, and the score of 4–6 has been referred to as an “intermediate microbiota” whose significance is incompletely characterized. Samples yielding a Nugent score greater than 3, i.e. both intermediate and BV together, have been referred to as “abnormal” vaginal flora or microbiota [7, 15, 16]
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