Comparison of Amsel’s criteria with low and high Nugent’s scores for the diagnosis of bacterial vaginosis

BACKGROUND: Bacterial vaginosis (BV) is the most common cause of vaginal discharge (VD) in women of reproductive age group. It is marked by displacement of beneficial Lactobacillus sp. by polymicrobial flora. BV is becoming a major public health concern as it is associated with adverse birth outcomes and increased susceptibility to sexually transmitted infections (STIs). Diagnosis of BV is currently done using clinical criteria (Amsel's) and the microbiological criteria (Nugent's scoring), the latter being the gold standard. Many out patient settings lack in microscopy facility and also skilled microbiologists, so reliance is placed on findings of clinical examination. AIMS AND OBJECTIVES: The aim of the study was to correlate Amsel's criteria with low (7–8) versus high (9–10) positive Nugent's scores for better understanding on utility of clinical criteria. MATERIAL AND METHODS: Patients with self-reported symptoms of vaginal discharge, genital itching were included and their pelvic examination was performed. Two swab samples were collected from lateral wall of vagina and posterior fornix and tested for BV infection using both Amsel's criteria and Nugent's score. RESULTS: Of the total 125 women, 29 (23.2%) were positive for BV by Amsel's criteria, whereas 34 (27.2%) were positive by Nugent's scoring. Amsel's criteria showed a sensitivity of 100% with high Nugent's scores and 81% with low scores, thereby implying very few cases of diseased individuals being missed. CONCLUSION: This study demonstrates the continued utility of the Clinical criteria in outpatient setting as a screening test.