found in our study was 19/600 (3.2%) similar to 1.07% by Sunita et al.
Clinicians must first consider whether each individual pathogen is present, in addition to then noting the presence of clue cells
, leukocytes, and lactobacilli.
The Amsel criteria includes production of a grey-white discharge, increased vaginal pH >4.5, positive whiff-amine test, and/ or >20 percent of observed epithelial cells seen are clue cells
. (2) In one study of 640 women evaluated for BV, observation of clue cells
was the most reliable diagnostic finding to predict BV.
Matching of the results of clue cells
in the Gram stain and isolation of G.
vaginalis bacteria effectively adhere to these exfoliated epithelial cells, thus producing clue cells
(6) The clue cells
that are typically found in BV arise from the subsequent desquamation of these epithelial cells.
. Clue cells
are vaginal epithelial cells coated with coccobacilli giving an appearance as if coated with ground black pepper.
Sensitivity and Specificity of Various Characteristics for BV Characteristic Sensitivity Specificity Vaginal discharge 0.74 0.52 pH [greater than or equal to] 4.5 0.84 0.80 Positive amine odor 0.71 0.97 Clue cells
present ([greater than]20%/high power field) 0.71 0.91 Elevated pH and amine odor 0.67 0.99 Elevated pH and clue cells
0.67 0.96 Clue cells
and amine odor 0.64 0.99 Amsel's criteria (at least three of four criteria) 0.68 0.98 Source: Dr.
The four diagnostic elements are: A vaginal fluid of pH>4.5, presence of "clue cells
" (Epithelial cells with unclear borders, dotted with bacteria) on microscopic examination of vaginal swab samples in normal saline, milky homogeneous, adherent vaginal discharge and a positive 'whiff test, which is accentuation of an amine or 'fishy' odor of discharge after addition of 10% potassium hydroxide.
Reporting clue cells
in the urine provides one piece of information to the clinician, but is not a definitive clinical finding to diagnose a urinary tract infection or a vaginal condition.
of BV BOH Gram (in years) Cases positive History Staining Cases < 19 02 -- -- -- 20-24 80 39 10 38 25-29 14 03 03 04 30-34 02 -- 01 -- >35 02 -- -- -- TOTAL 100 42 14 42 AGE Whiff Test Clue Cells
pH >4.5 (in years) Positive Positive < 19 -- -- -- 20-24 38 37 45 25-29 05 02 04 30-34 -- -- -- >35 -- -- -- TOTAL 43 39 49 Age No.
Using the criteria of Amsel et al, the classic diagnosis is indicated by the presence of three of the four following findings: (1) clinical evidence of an off-white creamy adherent vaginal discharge, (2) a vaginal pH greater than 4.5, (3) microscopic evidence of clue cells
(squamous epithelial cells coated by bacteria), and (4) a positive amine "sniff" test (a release of odoriferous volatile amines from an alkalinized vaginal specimen).