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Literature reviews > Articles for review > Culhane et al. Variation in Nugent score... |
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Bacterial vaginosis diagnosis by Nugent score does not vary by site of vaginal sample collection. Variation in Nugent score and leukocyte count in fluid collected from different vaginal sites. Question Do Nugent Gram stain scores for diagnosis of bacterial vaginosis (BV) and vaginal leukocyte counts differ depending on the vaginal site that is sampled? Design The variability in Nugent Gram stain scores and vaginal leukocyte counts was measured in vaginal secretions collected from 3 vaginal sites during routine pelvic examinations at the time of the first antenatal visit. Participants Fifty pregnant women less than 20 weeks gestation, consecutively enrolled from a routine prenatal care clinic at Thomas Jefferson Hospital, were tested.The mean age was 25 years; 74% were African-American.Women were excluded if they had vaginal bleeding, were less than 17 years old, or had any clinical sign of impending abortion or labor. Description of Tests and Diagnostic Standard Swabs were collected from each woman at 3 vaginal sites and smears were prepared.One swab was obtained from the vaginal introitus.One swab each was obtained from the mid-lateral vaginal wall and the posterior fornix after speculum insertion.The smears were air-dried, Gram stained, and scored according to the Nugent system.BV was diagnosed if the score was >7.Leukocyte counts were determined from the same smears by calculating the mean number in 5 oil immersion microscopic fields. Main Outcome Measures The Nugent scores and mean leukocyte counts were compared across the 3 vaginal collection sites. Main Results Forty-seven percent of the women were BV positive (Nugent score 7 to 10) and 53% were BV negative (Nugent score 0 to 3).There were no statistically significant differences in Nugent scores across the vaginal collection sites.All study participants had the same BV classification for all 3 sites.Leukocyte count did differ by site of collection.The mean values were 6.5, 2.8, and 2.5 leukocytes per oil immersion field for the introitus, mid-lateral wall, and posterior fornix smears, respectively.The differences between the introitus and the other two sites were significantly different (P = .001). Authors' Conclusions This study provides evidence that for assessing BV by the Nugent Gram stain score, self-sampling should not detract from the validity of the results.However, self-sampling for leukocyte assessment is not likely to yield consistent results and should probably not be used without further investigation. Source of funding:None given For correspondence:Jennifer F. Culhane, Department of Obstetrics and Gynecology, School of Public Health, Drexel University College of Medicine, 245 North 15th St., 17th floor (MS#495), Philadelphia, PA 19102.E-mail address: jfc92@drexel.edu. |
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