Evaluation and Comparison between Amsel’s Criteria and Nugent’s Score Methods in Diagnosis of Bacterial Vaginos is in Non-pregnant Women

Abstract

Aim: Bacterial vaginosis (BV) is a poly-microbial syndrome. Amsel’s criteria or Nugent’s methods are usually used for its diagnosis. The present study was conducted to compare these two techniques regarding their reliability and possible preferences in practical use. Study Design: A Cross-sectional research was designed. There was no time dimension while existing differences were identified and became base for grouping all cases involved in the study. Place and Duration of Study: Sabzevar, Iran, During 2012 to 2013. Methodology: Four hundreds and sixteen (416) non-pregnant women with abnormal vaginal discharges were evaluated for the presence of BV using Amsel’s criteria and Nugent’s tests. All clinical symptoms and a standard screening questionnaire were prepared and collected for each person. For each case following examinations were practiced: pH, Whiff test, a test in which vaginal secretions are mixed with 10% KOH resulting in a fishy odor typical of bacterial vaginosis, and the presence of the clue cells on vaginal wet smear. Gram staining method was performed for Nugent’s method. Results: Nugent’s score and Amsel’s criteria tests showed that the prevalence of BV was 8.2% and 16.4% respectively. There was no perfect inter-rater agreement between both Amsel’s and Nugent’s score (kappa = 0.58) tests. Presence of the clue cells among different diagnostic values provided the highest degree of assurance. Conclusion: Amsel’s criteria method is a cheap and convenient means for BV diagnosis. However, Nugent's method is not always reliable due to the complexity of scoring and expertise requirements. Although we need more evidence, the results suggested that the combination of the pH and clue cells test relatively was the best practical and reliable choice in clinical set for BV diagnosis.