Abnormal vaginal discharge: comparison of clinical and microbiological criteria for the diagnosis of bacterial vaginosis in western rajasthan, india

Abstract

Bacterial vaginosis (BV) is the commonest cause of abnormal vaginal discharge in women of child-bearing age with prevalence of 20-30%. BV is associated with increased susceptibility to HIV- AIDS, other sexually transmitted diseases and various obstetrics complications like preterm labour and miscarriage etc. BV is diagnosed by using Amsel’s, Hay/Ison and Nugent Criteria in which Nugent’s criterion is considered as the gold standard. Aim-Comparison of Amsel’s, Hay/Ison & Nugent criteria for diagnosis of bacterial vaginosis and to correlate with anaemia as an associated risk factor. Method- This prospective cross-sectional study involved 150 females of reproductive age group complaining of excessive vaginal discharge attending tertiary health centre at Dr. S.N. Medical College, Jodhpur, Rajasthan , India.Vaginal swabs were collected and the diagnosis of BV was done by using Amsel’s , Hay/Ison and Nugent Criteria on Gram stain. Results: Bacterial vaginosis was found in 30.66% women by Amsel’s Criteria, 28% by Hay/Ison Criteria and 26.66% by Nugent’s scoring .According to Hay’s Criteria:50% women having grade (1); 22% women lies in grade (2) & 28% in grade (3) .Nugent Criteria: Show score >7 in 26.67% women, score 4-7 in 25.33%; score 0-3 in 48% women. It was also observed that bacterial vaginosis diagnosed by Nugent’s score showed 50% women with Hb 5-8 gm/dl; 30% with Hb 9-12 gm/dl and 20% women with Hb >12gm/dl. Conclusion Although Nugent’s criterion is considered as the gold standard for the diagnosis of bacterial vaginosis, Amsel’s and Hay/Ison method showed good agreement with the gold standard method of Nugent et al. and can be used as an alternative to Nugent’s criteria in busy tertiary care centre. This study shows almost similar result for all three criteria used for diagnosis of Bacterial Vaginosis. This study also proves anemia as a risk factor.