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Good Positive and Negative Likelihood Ratios

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Bacterial Vaginosis: Likelihood Ratios

Introduction: None written.

[Edit Diagnosis] [Merge dx] [Add prevalence]

Tags: Gynecologic Infection Tag this Diagnosis.

The likelihood ratios of findings for Bacterial Vaginosis are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Finding +LR-LR Comments, Study
Amsel Criteria Edit 910.1

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 Edit 17.60.1

    This is a test for sialidase activity.

    Study: J Clin Microbiol. 2005 Mar;43(3):1304-8. PMID: 15750100

    Vaginal pH Edit 4.40.1

    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.

    Clinical diagnosis Edit 2.70.3

    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

    Good Positive Likelihood Ratio

    Finding +LR-LR Comments, Study
    Clue Cells Edit 3.40.6

    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

    Poorly Diagnostic Findings

    Finding +LR-LR Comments, Study
    Whiff Test Edit 0.51.1

    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

    Findings With Unspecified Accuracy

    Finding +LR-LR Comments, Study
    Nugent Criteria Edit 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