Nugent Gram Stain Research Articles

Prevalence and epidemiological correlates of bacterial vaginosis among nonpregnant females at a tertiary care center in Assam, India

Purpose: Bacterial vaginosis is the most common type of vaginal infection among women of reproductive age and accounted for at least one-third of all vulvovaginal infections. The main aim of this prospective study was to determine the risk factors that may be associated with the occurrence of bacterial vaginosis among the reproductive age group females in Assam. Materials and Methods: A total of two hundred married, nonpregnant females in the reproductive age group who complained of one or more symptoms suggesting lower genital tract infection were enrolled in this study. Detailed history of the patients was taken. Three high vaginal swabs were obtained after informed consent of the patients. Bacterial vaginosis was diagnosed on the basis of Amsel's clinical criteria and Nugent's Gram stain scoring method. Data was statistically analyzed using Chi-square test. Results: Our study found prevalence of bacterial vaginosis to be 51.5% (103/200) by Amsel's criteria and 49% (98/200) by Nugent's criteria respectively. Significant association was found between bacterial vaginosis and age, socioeconomic status, parity and contraceptives. However, no significant association was found between duration of marriage and stage of the menstrual cycle. Conclusion: A relatively higher prevalence rate of bacterial vaginosis was found in the population under study, which may be attributed to factors like low socioeconomic status and unhygienic practices. Barrier contraception was found to be an effective method for prevention of transmission of bacterial vaginosis. However, more studies may be needed to confirm and evaluate the causes of these associations, so that a preventive strategy can be planned.

Bacterial Vaginosis Is Associated with Variation in Dietary Indices ,

Bacterial vaginosis (BV) is a common condition of unknown etiology and has been linked to adverse reproductive and obstetric health outcomes. Prior dietary research on BV has focused on specific macro- and micronutrients, but not dietary indices. We assessed the relationship between BV and selected dietary indicators among a cohort of 1735 nonpregnant women ages 15–44 y from Birmingham, Alabama. Annual intake was assessed with the Block98 FFQ, and the glycemic index, glycemic load (GL), and Healthy Eating Index were calculated by the Block Dietary Data System. The Naturally Nutrient Rich (NNR) score was also calculated. Vaginal flora was evaluated using Nugent Gram-stain criteria. Crude OR and adjusted OR were determined by multinomial and logistic regression in cross-sectional and prospective analyses, respectively. Participants were predominantly African American (85.5%) aged 25.3 ± 6.8 y (mean ± SD). Per 10-unit increase, GL was positively (adjusted OR = 1.01, 95% CI = 1.00–1.03) and NNR was negatively (adjusted OR = 0.93, 95% CI = 0.88–0.99) associated with BV compared to normal vaginal flora. In prospective analyses, only GL was associated with BV progression (adjusted OR = 1.03, 95% CI = 1.00–1.05) and persistence (adjusted OR = 1.02, 95% CI = 1.01–1.04) after adjustment. Both GL and NNR were associated with greater BV prevalence and GL was associated with an increase in BV persistence and acquisition. These results suggest that diet composition may contribute to vaginal flora imbalances and be important for elucidating the etiology of BV.

Comparison of the BD Affirm VPIII Test to Primary Care and Clinical Laboratory Methods for the Diagnosis of Bacterial Vaginosis and Yeast Vaginitis

Background: Diagnosis of bacterial vaginosis (BV) or yeast vaginitis (YV) in the primary care physician's (PCP's) office has relied on patient symptoms, clinical findings during vaginal examination, and analysis of vaginal fluid. These approaches support PCP decisions when selecting patient treatment regimens for these conditions. Alternatively, vaginal specimens may be tested at a clinical or hospital-based laboratory where other diagnostic methods are used including the Nugent Gram stain (NGS), culture, or molecular methods. This study compared these methods and the BD Affirm VPIII (AFF) test to the diagnosis provided by the PCP. Methods: Eighty-four patients were enrolled at 3 primary care sites. Each site used routine Amsel criteria for BV and wet mount for YV. Three additional vaginal swabs were collected: the first was used to perform a NGS for BV; the second was used for yeast culture; and the third for testing with the AFF, a DNA probe-based method. Primary care physicians diagnosed and treated 36 patients for BV and 30 patients for YV. Results: Using a NGS score indicative of BV (>6), the sensitivity and specificity of Amsel criteria, AFF, and Nugent GS for BV was 95% and 57%, 100% and 71%, and 50% and 100%, respectively. For YV, the sensitivity and specificity of the wet mount, AFF, and yeast culture was 100% and 11%, 86% and 100%, and 100% and 100%, respectively. Several patients were misdiagnosed and treated inappropriately for BV and YV. Conclusions: The AFF outperformed and provided a faster result than traditional testing done in the PCP or clinical laboratory setting.

Longitudinal Changes in Vaginal Microbiota Composition Assessed by Gram Stain Among Never Sexually Active Pre- and Postmenarcheal Adolescents in Rakai, Uganda

Study Objective To describe changes in vaginal microbiota and pH over time among never sexually active adolescents at different menarcheal stages. Design A cohort of 49 sexually inexperienced Ugandan adolescents provided weekly self-collected vaginal swabs and behavioral/health information for up to two years. Menarcheal stage was classified as: not experiencing menarche during follow-up (premenarcheal, n = 9), achieving menarche during follow-up (perimenarcheal, n = 20), and being postmenarcheal (n = 20) at enrollment. Vaginal microbiota were characterized as morphotypes of large gram-positive rods, small gram-negative or variable rods, and curved gram-negative rods based on Nugent Gram-stain criteria. Baseline measures were compared using nonparametric tests. Mean changes (β) in morphotypes and pH over time were estimated using longitudinal mixed-effects models. Results The baseline median (IQR: interquartile range) Nugent score was 8 (7–8) in premenarcheal, 4.5 (1–8) in perimenarcheal, and 1 (0–3) in postmenarcheal girls ( P = 0.001). For each respective menarcheal stage, the median (IQR) counts of gram-positive rods were 0 (0–0), 10 (0–30), and 30 (18–30) ( P = 0.002) and gram-negative or variable rods were 30 (30–30), 16 (0.5–30), and 0.5 (0–2.5) ( P = 0.002) at enrollment. Counts of gram-positive rods increased (β = 0.259, 95% CI: 0.156, 0.362) and gram-negative or variable rods decreased (β = -0.201, 95% CI:-0.298,-0.103) significantly over time in premenarcheal girls, but not in other groups. Vaginal pH declined significantly in peri- and postmenarcheal girls only. Conclusion Vaginal microbiota composition varied by menarcheal stage at enrollment. Over time, significant changes in vaginal morphotypes occurred in premenarcheal girls, suggesting this may be an important period of transition.