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Journal of Clinical Microbiology, September 2005, p. 4607-4612, Vol. 43, No. 9
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.9.4607-4612.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.

Utility of Amsel Criteria, Nugent Score, and Quantitative PCR for Gardnerella vaginalis, Mycoplasma hominis, and Lactobacillus spp. for Diagnosis of Bacterial Vaginosis in Human Immunodeficiency Virus-Infected Women

Beverly E. Sha,1* Hua Y. Chen,2 Qiong J. Wang,2 M. Reza Zariffard,3 Mardge H. Cohen,4 and Gregory T. Spear3

Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, Chicago, Illinois,1 Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois,2 Department of Immunology/Microbiology, Rush University Medical Center, Chicago, Illinois,3 Department of Medicine, CORE Center, Cook County Bureau of Health Sciences, Chicago, Illinois4

Received 28 January 2005/ Returned for modification 10 March 2005/ Accepted 3 June 2005

Bacterial vaginosis (BV) is a clinical syndrome presenting with a malodorous vaginal discharge and increased vaginal pH. Diagnosis has been based on clinical Amsel criteria and direct Gram stain of vaginal secretions. Human immunodeficiency virus (HIV)-infected participants in the Women's Interagency HIV Study contributed cervicovaginal lavage (CVL) samples. Lactobacilli, Gardnerella vaginalis, and Mycoplasma hominis in cervicovaginal lavage samples were quantified by PCR. Gynecologic evaluation included Nugent score and Amsel criterion assessment. We compared the gold standard Nugent score to Amsel criteria and quantitative bacterial PCR for diagnosing BV in 203 CVL samples from women with Nugent scores of 7 to 10 (BV group) and 203 samples from women with BV Nugent scores of 0 to 3 ("No-BV" group). Only 75 of the 203 CVL samples from women with Nugent scores of 7 to 10 met positive Amsel criteria. Increasing levels of G. vaginalis and M. hominis and decreasing levels of lactobacilli were significantly associated with BV by Nugent score. Of the group with Nugent scores of 7 to 10, 83% and 81% had log10 G. vaginalis counts and log10 M. hominis counts greater than 6.81 and 4.82, respectively, while only 30% and 31% of the group with Nugent scores of 0 to 3 were above these thresholds, respectively. There was significant overlap in the log10 lactobacillus counts between the two groups. Utilizing all three log10 bacterial counts (G. vaginalis, M. hominis, and lactobacilli) in our model improved the sensitivity and specificity to 83% and 78%, respectively, in comparison with Nugent score. In this cohort, Amsel criteria were poorly predictive of BV. PCR quantification of G. vaginalis and M. hominis from CVL is significantly more sensitive than Amsel criteria for diagnosing BV.

* Corresponding author. Mailing address: Department of Medicine, Section of Infectious Diseases, Rush University Medical Center, 600 S. Paulina, Suite 143, Chicago, IL 60612. Phone: (312) 942-5865. Fax: (312) 942-8200. E-mail: bsha{at}rush.edu.

Journal of Clinical Microbiology, September 2005, p. 4607-4612, Vol. 43, No. 9
0095-1137/05/$08.00+0     doi:10.1128/JCM.43.9.4607-4612.2005
Copyright © 2005, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Fredricks, D. N., Fiedler, T. L., Thomas, K. K., Mitchell, C. M., Marrazzo, J. M. (2009). Changes in Vaginal Bacterial Concentrations with Intravaginal Metronidazole Therapy for Bacterial Vaginosis as Assessed by Quantitative PCR. J. Clin. Microbiol. 47: 721-726 [Abstract] [Full Text]  


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