J Clin Gynecol Obstet

Journal of Clinical Gynecology and Obstetrics, ISSN 1927-1271 print, 1927-128X online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Gynecol Obstet and Elmer Press Inc

Journal website http://www.jcgo.org

Review

Volume 3, Number 1, February 2014, pages 1-7

Current Concept of Bacterial Vaginosis in Cervical Cancer

Figure 1. a) Staphylococcus aureus on blood agar (BA), isolated from High Vaginal Swab (HVS) sample, taken from cervical cancer patient. b) Klebsiella pneumonia on MacConkey agar (Mac), isolated from HVS sample, taken from cervical cancer patient.

**Table 1.** Characteristics of Selected Studies in BV
Year of publication	Authors	Country	Age range (Years)	HPV Prev (%)	BV Diagnosis	BV Prev (%)
Reproduce from Gillet et al [7]. Association between BV and CIN: systematic review and meta-analysis. BMC Infectious Disease 2011;1-9.
1995	Peters et al	Netherlands	20-66	71.1	Amsel	20.0
1997	Sikstrom et al	Sweden	-	6.8	Amsel	13.0
2001	Castle et al	Costa Rica	-	59.6	Nugent	37.8
2003	Mao et al	USA	18-24	22.8	Amsel	3.0
2003	Boyle et al	UK	16-58	21.1	Amsel	30.9
2004	da Silva et al	Brazil	15-35	50.0	Amsel	34.6
2005	Watts et al	USA	-	56.1	Nugent	43.7
2005	Samoff et al	USA	13-19	53.5	Nugent	47.2
2008	Figueiredo et al	Brazil	-	84.2	Clue cells	17.0
2009	Verteramo et al	Italy	17-58	31.0	Amsel	6.3
2009	Nam et al	South-Korea	-	69.1	Amsel	11.0
2009	Rahkola et al	Finland	18-69	53.3	Clue cells	15.2

Table 1. Characteristics of Selected Studies in BV

Year of publication

Authors

Country

Age range (Years)

HPV Prev (%)

BV Diagnosis

BV Prev (%)

Reproduce from Gillet et al [7]. Association between BV and CIN: systematic review and meta-analysis. BMC Infectious Disease 2011;1-9.

1995

Peters et al

Netherlands

20-66

71.1

Amsel

20.0

1997

Sikstrom et al

Sweden

6.8

Amsel

13.0

2001

Castle et al

Costa Rica

59.6

Nugent

37.8

2003

Mao et al

USA

18-24

22.8

Amsel

3.0

2003

Boyle et al

16-58

21.1

Amsel

30.9

2004

da Silva et al

Brazil

15-35

50.0

Amsel

34.6

2005

Watts et al

USA

56.1

Nugent

43.7

2005

Samoff et al

USA

13-19

53.5

Nugent

47.2

2008

Figueiredo et al

Brazil

84.2

Clue cells

17.0

2009

Verteramo et al

Italy

17-58

31.0

Amsel

6.3

2009

Nam et al

South-Korea

69.1

Amsel

11.0

2009

Rahkola et al

Finland

18-69

53.3

Clue cells

15.2

**Table 2.** *Amsel* and *Nugent* Diagnostic Criteria
Amsel criteria	Nugent Score criteria
Amsel criteria is a criteria for clinical diagnosis of bacterial vaginosis. The diagnosis is made if three of the following four criteria are positive:	The Nugent Score is a Gram stain scoring system for pap tests to diagnose bacterial vaginosis. The Nugent score is calculated by assessing for the presence of :
1) Homogeneous vaginal discharge (color and amount may vary).	1) large Gram positive rods (Lactobacillus morphotypes; decrease in Lactobacillus scored as 0 to 4).
2) Amine (fishy) odor when potassium hydroxide solution is added to vaginal secretions (commonly called the “whiff test”).	2) small Gram-variable rods (Gardnerella vaginalis morphotypes; score as 0 to 4).
3) Presence of clue cells (greater than 20%) on microscopy.	3) curved Gram-variable rods (Mobiluncus spp. Morphotypes; score as 0 to 2) and can range from 0 to 10. A score of 7 to 10 is consistent with bacterial vaginosis.
4) Vaginal pH greater than 4.5.

Table 2. Amsel and Nugent Diagnostic Criteria

Amsel criteria

Nugent Score criteria

Amsel criteria is a criteria for clinical diagnosis of bacterial vaginosis. The diagnosis is made if three of the following four criteria are positive:

The Nugent Score is a Gram stain scoring system for pap tests to diagnose bacterial vaginosis. The Nugent score is calculated by assessing for the presence of :

1) Homogeneous vaginal discharge (color and amount may vary).

1) large Gram positive rods (Lactobacillus morphotypes; decrease in Lactobacillus scored as 0 to 4).

2) Amine (fishy) odor when potassium hydroxide solution is added to vaginal secretions (commonly called the “whiff test”).

2) small Gram-variable rods (Gardnerella vaginalis morphotypes; score as 0 to 4).

3) Presence of clue cells (greater than 20%) on microscopy.

3) curved Gram-variable rods (Mobiluncus spp. Morphotypes; score as 0 to 2) and can range from 0 to 10. A score of 7 to 10 is consistent with bacterial vaginosis.

4) Vaginal pH greater than 4.5.