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Bacterial Vaginosis: Sensitivity and Specificity

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Tags: Gynecologic Infection Tag this Diagnosis.

The sensitivity and specificity of findings for Bacterial Vaginosis are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive and Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Amsel Criteria	+ 0 -	91%	99%
3/4: thin, white, homogeneous discharge clue cells pH > 4.5 + Whiff test for Nugent score 7-10 Study: J Clin Microbiol. 2005 Mar;43(3):1304-8. PMID: 15750100
[ + ] BVBlue Point-of-Care Test	+ 0 -	88%	95%
This is a test for sialidase activity. Study: J Clin Microbiol. 2005 Mar;43(3):1304-8. PMID: 15750100

Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] Whiff Test	+ 0 -	6.7%	85.9%
Adding 10% KOH to the vaginal discharge yields a fishy odor (NOT diagnostic!!) Study: Infect Dis Obstet Gynecol. 2001;9(2):105-11. PMID: 11495550

Sensitive Findings
Finding	Result	Sensitivity	Specificity
[ + ] Vaginal pH	+ 0 -	96%	78%
pH > 4.5 Study: The Nugent method is a standardized point scoring system (scores from 0 to 10) based on the presence of three bacterial morphotypes: large gram-positive rods (Lactobacillus spp.), small gram-negative or gram-variable coccobacilli (Gardnerella and anaerobic spp.), and curved gram-variable rods (Mobiluncus spp.) (16). A Nugent score (NS) of 0 to 3 is classified as the presence of normal flora, an NS of 4 to 6 is classified as the presence of an intermediate increase in flora (intermediate flora), and an NS of 7 to 10 is classified as BV.

Negative Findings
Finding	Result	Sensitivity	Specificity
[ + ] Whiff Test	+ 0 -	6.7%	85.9%
Adding 10% KOH to the vaginal discharge yields a fishy odor (NOT diagnostic!!) Study: Infect Dis Obstet Gynecol. 2001;9(2):105-11. PMID: 11495550

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] Clue Cells	+ 0 -	53.3%	84.2%
on vaginal wet mount: >20% Another study evaluating for "clue cells present" gave sens=96%, spec=99% Study: Infect Dis Obstet Gynecol. 2001;9(2):105-11. PMID: 11495550 alt: J Clin Microbiol. 2005 Mar;43(3):1304-8. PMID: 15750100
[ + ] Clinical diagnosis	+ 0 -	80.8%	70%
The clinical examination included a speculum examination for observation of mucopurulent cervicitis and evaluation of secretions for color, viscosity, and homogeneity. Vaginal specimens were collected for wet-prep microscopy (normal saline and 10% potassium hydroxide slides), whiff (amines) test using 10% potassium hydroxide added to the vaginal secretions, and determination of vaginal secretion pH (Phenazine Paper, Decon Laboratories, Inc., King of Prussia, PA). Study: Obstet Gynecol. 2009 Jan;113(1):89-95. PMID: 19104364

Findings With Unspecified Accuracy
Finding	Result	Sensitivity	Specificity
[ + ] Nugent Criteria		No accuracy specified.
on Gram stain, Gardnerella and/or Mobiluncus predominate with few or no Lactobacilli The Nugent method is a standardized point scoring system (scores from 0 to 10) based on the presence of three bacterial morphotypes: large gram-positive rods (Lactobacillus spp.), small gram-negative or gram-variable coccobacilli (Gardnerella and anaerobic spp.), and curved gram-variable rods (Mobiluncus spp.) (16). A Nugent score (NS) of 0 to 3 is classified as the presence of normal flora, an NS of 4 to 6 is classified as the presence of an intermediate increase in flora (intermediate flora), and an NS of 7 to 10 is classified as BV. Study: J Clin Microbiol. 2005 Mar;43(3):1304-8. PMID: 15750100