Modak Tamonud, Arora Preeti, Agnes Charan, Ray Raja, Goswami Sebanti, Ghosh Pramit, Das Nilay Kanti
Department of Dermatology , Medical College and Hospital, Kolkata, West Bengal, India.
J Infect Dev Ctries. 2011 May 28;5(5):353-60. doi: 10.3855/jidc.1153.
Bacterial vaginosis is a polymicrobial syndrome involving replacement of normal vaginal hydrogen peroxide producing lactobacilli by a variety of mycoplasmas and Gram-negative rods. Bacterial vaginosis has been conventionally diagnosed using Amsel criteria (a clinical method) or Nugent's score (a laboratory method with higher reproducibility). This study was undertaken to compare the diagnostic ability of the Amsel criteria with that of Nugent's score among patients presenting with abnormal vaginal discharge.
The study was conducted at the Medical College in Kolkata, India to determine the prevalence of patients with bacterial vaginosis and their demographic profile. Subjects attending the outpatient department presenting with abnormal vaginal discharge were evaluated for the presence of bacterial vaginosis by Amsel criteria and Nugent's score.
Prevalence of bacterial vaginosis was 24% by Nugent's score. In comparison, Amsel criteria had sensitivity of 66.67%, specificity of 94.74%, positive predictive value of 80% and negative predictive value of 90%. There was no perfect inter-rater agreement between the Amsel criteria and Nugent's score (Kappa = 0.58). Presence of clue cells correlated best with a positive diagnosis by Nugent's score while the amine test (whiff test) had the lowest correlation.
Although the Amsel criteria method is a convenient and inexpensive means of diagnosing bacterial vaginosis, it is not always reliable. Alternative reliable and inexpensive diagnostic methods that unify clinical and microbiological parameters, thus increasing sensitivity while retaining specificity, are needed.
细菌性阴道病是一种多微生物综合征，其特征是正常产生过氧化氢的阴道乳酸杆菌被多种支原体和革兰氏阴性杆菌所取代。传统上，细菌性阴道病采用阿姆塞尔标准（一种临床方法）或纽金特评分（一种具有更高重现性的实验室方法）进行诊断。本研究旨在比较阿姆塞尔标准与纽金特评分在阴道分泌物异常患者中的诊断能力。
该研究在印度加尔各答的医学院进行，以确定细菌性阴道病患者的患病率及其人口统计学特征。对到门诊就诊且有阴道分泌物异常的受试者，采用阿姆塞尔标准和纽金特评分评估其是否患有细菌性阴道病。
根据纽金特评分，细菌性阴道病的患病率为24%。相比之下，阿姆塞尔标准的敏感性为66.67%，特异性为94.74%，阳性预测值为80%，阴性预测值为90%。阿姆塞尔标准与纽金特评分之间不存在完美的评分者间一致性（kappa系数=0.58）。线索细胞的存在与纽金特评分的阳性诊断相关性最佳，而胺试验（嗅试验）的相关性最低。
尽管阿姆塞尔标准方法是诊断细菌性阴道病的一种便捷且廉价的手段，但它并不总是可靠的。需要有可靠且廉价的替代诊断方法，将临床和微生物学参数统一起来，从而在保持特异性的同时提高敏感性。
