From the Guidelines
Bacterial vaginosis can be diagnosed using a combination of clinical assessment and laboratory testing, with the most recent and highest quality study suggesting that clinical criteria, such as Amsel's criteria, can be used to diagnose BV 1.
Diagnostic Criteria
The clinical diagnosis of bacterial vaginosis relies on Amsel's criteria, which requires the presence of at least three of the following four signs:
- Thin, homogeneous vaginal discharge
- Vaginal pH greater than 4.5
- Positive whiff test (fishy odor when potassium hydroxide is added to vaginal secretions)
- Presence of clue cells on microscopic examination of vaginal fluid
Laboratory Testing
Laboratory testing, such as Gram staining of vaginal secretions, can also be used to diagnose bacterial vaginosis, but it is not always necessary 1.
Treatment
Treatment of bacterial vaginosis typically involves antibiotics, such as metronidazole or clindamycin, and the choice of treatment should be based on the clinical situation and the results of diagnostic testing 1.
Key Points
- Bacterial vaginosis is a common lower genital tract syndrome among women of reproductive age
- The diagnosis of BV can be made using clinical criteria, such as Amsel's criteria
- Laboratory testing, such as Gram staining, can also be used to diagnose BV
- Treatment of BV typically involves antibiotics, such as metronidazole or clindamycin
- The choice of treatment should be based on the clinical situation and the results of diagnostic testing 1
From the FDA Drug Label
A clinical diagnosis of bacterial vaginosis was defined as all of (a) the presence of an off-white (milky or gray), thin, homogeneous vaginal discharge; (b) a vaginal pH ≥ 4. 7; (c) the presence of Clue cells ≥ 20% of the total epithelial cells on a microscopic examination of the vaginal saline wet mount; (d) a positive "whiff" test (detection of amine odor on addition of 10% KOH solution to a sample of the vaginal discharge); and (e) a Nugent score ≥ 4 A clinical diagnosis of bacterial vaginosis was based on Amsel's criteria and defined by the presence of an abnormal homogeneous vaginal discharge that (a) has a pH of greater than 4. 5, (b) emits a "fishy" amine odor when mixed with a 10% KOH solution, and (c) contains ≥20% clue cells on microscopic examination.
Bacterial vaginosis can be diagnosed clinically using Amsel's criteria, which includes the presence of an abnormal homogeneous vaginal discharge, a pH of greater than 4.5, a "fishy" amine odor, and ≥20% clue cells on microscopic examination 2 3.
- The diagnosis is based on the presence of specific clinical criteria, including vaginal discharge, pH, and microscopic examination.
- Laboratory testing, such as a Nugent score, may also be used to support the diagnosis, but it is not always necessary.
From the Research
Diagnosis of Bacterial Vaginosis
Bacterial vaginosis can be diagnosed through a combination of clinical evaluation and laboratory testing. The diagnosis is often made using the Amsel criteria, which include:
- Characteristic discharge
- pH of 5 or greater
- Clue cells
- A positive KOH amine test 4 Alternatively, a Gram stain can be used as a diagnostic standard 5, 6, 7.
Clinical Diagnosis
A clinical diagnosis of bacterial vaginosis can be made by detecting three of the Amsel criteria 4, 7. This approach is commonly used in clinical practice, as it is relatively simple and does not require laboratory testing.
Laboratory Testing
Laboratory testing, such as Gram stain or DNA testing, can be used to confirm the diagnosis of bacterial vaginosis 5, 6, 7. These tests can help to identify the presence of Gardnerella vaginalis and other anaerobic bacteria that are characteristic of the condition.
Treatment
Treatment of bacterial vaginosis typically involves the use of antibiotics, such as metronidazole or clindamycin 8, 4, 5, 6, 7. The choice of treatment will depend on the severity of the symptoms and the presence of any underlying medical conditions.