A pH indicator to detect vaginal alkalinization (here showing approximately pH 8), and a microscope slide to microscopically detect clue cells To make a diagnosis of bacterial vaginosis, a swab from inside the vagina should be obtained. These swabs can be tested for: *Gram stain which shows the depletion of lactobacilli and overgrowth of Gardnerella vaginalis bacteria. Bacterial vaginosis is usually confirmed by a Gram stain of vaginal secretions. * A characteristic "fishy" odor on wet mount. This test, called the whiff test, is performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge. A characteristic fishy odor is considered a positive whiff test and is suggestive of bacterial vaginosis. * Loss of acidity. To control bacterial growth, the vagina is normally slightly acidic with a pH of 3.8–4.2. A swab of the discharge is put onto litmus paper to check its acidity. A pH greater than 4.5 is considered alkaline and is suggestive of bacterial vaginosis. * The presence of clue cells on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge. These are epithelial cells that are coated with bacteria. Differential diagnosis for bacterial vaginosis includes the following: * Normal vaginal discharge. * Candidiasis (thrush, or a yeast infection). * Trichomoniasis, an infection caused by Trichomonas vaginalis. * Aerobic<unk>  The Center for Disease Control (CDC) defines STIs as "a variety of clinical syndromes and infections caused by pathogens that can be acquired and transmitted through sexual activity." But the CDC does not specifically identify BV as sexually transmitted infection. Amsel criteria In clinical practice BV can be diagnosed using the Amsel criteria: # Thin, white, yellow, homogeneous discharge # Clue cells on microscopy # pH of vaginal fluid >4.5 # Release of a fishy odor on adding alkali—10% potassium hydroxide (KOH) solution. At least three of the four criteria should be present for a confirmed diagnosis. A modification of the Amsel criteria accepts the presence of two instead of three factors and is considered equally diagnostic. Gram stain An alternative is to use a Gram-stained vaginal smear, with the Hay/Ison criteria or the Nugent criteria. The Hay/Ison criteria are defined as follows: * Grade 1 (Normal): Lactobacillus morphotypes predominate. * Grade 2 (Intermediate): Some lactobacilli present, but Gardnerella or Mobiluncus morphotypes also present. * Grade 3 (Bacterial Vaginosis): Predominantly Gardnerella and/or Mobiluncus morphotypes. Few or absent lactobacilli. (Hay et al., 1994) Gardnerella vaginalis is the main culprit in BV. Gardnerella vaginalis is a short rod (coccobacillus). Hence, the presence of clue cells and gram variable coccobacilli are indicative or diagnostic of bacterial vaginosis. Nugent score The Nugent score is now rarely used by physicians due to the time it takes to read the slides and requires the use of a trained microscopist. A score of 0-10 is generated from combining three other scores. The scores are as follows: * 0–3 is considered negative for BV * 4–6 is considered intermediate * 7+ is considered indicative of BV. At least 10–20 high power (1000× oil immersion) fields are counted and an average determined. Lactobacillus morphotypes – average per high powered (1000× oil immersion) field. View multiple fields. Gardnerella / Bacteroides morphotypes – average per high powered (1000× oil immersion) field. View multiple fields. Curved Gram variable rods – average per high powered (1000× oil immersion) field. View multiple fields (note that this factor is less important – scores of only 0–2 are possible) * Score 0 for >30 * Score 1 for 15–30 * Score 2 for 14 * Score 3 for 0, yet 0, yet 30 * Score 0 for 0 * Score 1 for <5 * Score 2 for 5+ DNA hybridization testing with Affirm VPIII was compared to the Gram stain using the Nugent criteria. The Affirm VPIII test may be used for the rapid diagnosis of BV in symptomatic women but uses expensive proprietary equipment to read results, and does not detect other pathogens that cause BV, including Prevotella spp, Bacteroides spp, and Mobiluncus spp. The cervicovaginal microbiome measured using 16S rRNA sequencing has the capacity to increase throughput of the Nugent Score and has demonstrate to be directly comparable to clinical Nugent Score measurement. Screening Screening during pregnancy is not recommended in the United States as of 2020.
medical cause of Vaginitis
medical cause of Dysmenorrhea
symptom of Vaginal yeast infection
symptom of Vaginitis
symptom of Pelvic inflammatory disease
symptom of Ectopic pregnancy
symptom of Bacterial vaginosis
symptom of Urethral cancer