Diagnosis

© BV is diagnosed according to the Amsel criteria. In order for diagnosis to be confirmed, three of the four criteria must be present:

1. Thin, white, homogenous discharge

2. Clue cells on microscopy (clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria)

3. pH of vaginal fluid greater than 4.5

4. Release of a fishy odor upon the addition of an alkali (10% potassium hydroxide) to a vaginal sample.

© Alternatively, a gram-stain vaginal smear may be used to diagnose BV using the Nugent criteria. This relies on estimating the proportions of bacteria morphotypes to provide a score between 0 and 10. A score of less than 4 is normal, 4 to 6 is intermediate, and greater than 6 is consistent with BV. Isolation of G. vaginalis may not be diagnostic because it can be cultured from the vagina in some normal women, although a high concentration may be indicative of infection.36

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