Bacterial vaginosis diagnosis. Clinical aspects and microbiologic studies

Abstract

Bacterial vaginosis is a frequent disorder of the vaginal flora in reproductive-age women, characterized by the presence of a grey unpleasant smelling secretion, due to the decrease of lactobacilli, the vaginal Ph increase and the presence of anaerobic bacteria. It is estimated that around 30 % of women aged 14-49 years have bacterial vaginosis. It is associated with perinatologic diseases including: premature membrane breaking, premature birth, low-weight newborns and inflammatory pelvic disease. The bacterial vaginosis diagnosis could be made applying clinical criteria (Amsel criteria) or by evaluation of the bacterial morphotypes found in the vaginal secretion gram through microbiological procedures created as an alternative to the clinical diagnosis that gradually replaced it. The firstly described and standardized microbiological methods were the Spiegel's and Nugent's ones. Later, Ison and Hay widened Nugent's evaluation system, including two new categories respectively, emphasizing the dominance of gram positive cocci in the vaginal ecosystem and the absence of bacteria in a smear. The most recent study on the theme is the validation of the study Vaginal Content Balance (VACOBA), showing that Nugent's and Amsel's criteria integration increases the test sensibility and specificity.