Evaluation of various diagnostic modalities for detection of bacterial vaginosis and aerobic vaginitis: An underdiagnosed entity among women of the reproductive age group.

Background: Bacterial vaginosis (BV) and aerobic vaginitis (AV) have been encountered as the most common vaginal infections among women of the reproductive age group. Bedside diagnosis of BV can be made by Amsel's criteria or modified Amsel's criteria by clinicians. However, Nugent scoring is the recommended method for its diagnosis. AV is usually underdiagnosed. The recommended technique is microscopic-based Donder's criteria. However, Gram's stain and culture are routinely used for AV diagnosis.

Objective Of The Study: The present study was conducted to compare various diagnostic modalities used for diagnosing BV and AV among nonpregnant symptomatic women of the reproductive age group (15-49 years).

Materials And Methods: All symptomatic nonpregnant women attending the gynecology outpatient department between 15 and 49 years of age were included in the study. Three swabs were collected for wet mount for Donder's criteria (AV), Gram stain for Nugent scoring (BV), and aerobic culture. Amine odor and pH were tested bedside for BV infection using Amsel's criteria and modified Amsel's criteria.

Result: A total of 150 patients were tested during the study period (January 21 to July 22). The prevalence of BV as per Nugent score was found as 22%. Amsel's criteria had a higher specificity (92.31%) and positive predictive value (PPV) (76.32%), while modified Amsel's criteria were more sensitive (96.97%) with a higher negative predictive value (NPV) (98.75%). The sensitivity of pH test, Gram stain, and culture individually were 88.46%, 73.08%, and 61.54%, respectively, with Donder's criteria being the gold standard.

Discussion And Conclusion: Modified Amsel's criteria may continue to be used as a screening test in countries with high prevalence of BV, but all such screen-positive women should be further subjected to Nugent scoring for confirmatory diagnosis. Gram stain with culture in combination can replace the Donder's criteria for diagnosis of AV infection.