Clinical diagnosis of bacterial vaginosis

Objective: To evaluate the accuracy of Amsel's criteria individually or in combinations of two for the clinical diagnosis of bacterial vaginosis. Methods: This cross-sectional study enrolled. 135 women at UNICAMP, and evaluated Amsel's four clinical criteria. Sensitivity, specificity, positive and negative predictive values were calculated for each criterion individually, in combinations of two, and for the classic test with at least three criteria present. The Nugent method was used as gold standard. Results: The most sensitive individual criteria were pH and vaginal discharge (97%), the latter having lowest specificity (26%). The criterion with highest specificity was the presence of clue cells (86%). The combination of two criteria showed sensitivity of 83% to 93%, and specificity of 82% to 94%. Conclusion: The accuracy of Amset's clinical criteria individually or in combinations of two was as accurate as the presence of at least three criteria for the diagnosis of bacterial vaginosis. (c) 2006 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.941283

Is bacterial vaginosis associated with squamous intraepithelial lesion of the uterine cervix?

The objective of this study was to analyze the association between bacterial vaginosis (BV) and squamous intracpithelial lesion (SIL). Pap smears m,ere analyzed to verify the presence of BV and SIL. One hundred and ten women with SIL comprised the study group, while 110 women with no cytological abnormalities served as controls. BV was similarly present in women of both groups: 18% of women with SIL and 12% of women without SIL. Results were also similar when the grade of SIL was taken into consideration. BV was detected in 16% of women with low-grade SIL and in 12% of women in the control group, while a higher rate of BV (33%) was found among women with high-grade SIL in comparison to the controls (12%). This difference, however, was not statistically significant. BV tended to be more common among women with high-grade SIL than in women with no cytological abnormalities. Diagn. Cytopathol. 2006; 34:323-325. (c) 2006 Wiley-Liss, Inc.34532332

Presence of 20% or more clue cells: An accurate criterion for the diagnosis of bacterial vaginosis in Papanicolaou cervical smears

A study was carried out in 135 women of reproductive age to evaluate the role of the Papanicolaou smear performed in cervical and vaginal samples for the diagnosis of bacterial vaginosis (BV), to validate the method for this diagnosis and to evaluate the reproducibility of the criterion used. The cervical and vaginal smears were stained using the Papanicolaou method and evaluated by two separate observers. The finding of 20% or more clue cells was considered positive for the presence of BV. This diagnostic criterion presented a sensitivity of 87%, specificity of 94%, a positive predictive value of 81 %, and a negative predictive value of 96%, both in cervical and vaginal samples. There vvas excellent agreement in the diagnosis of BV between the two observers (kappa, 0.87) and between cervical and vaginal samples (kappa, 0.92). Therefore, the presence of 20% or more clue cells in the Papanicolaou smear is all accurate and reproducible criterion for the diagnosis of BV and may be used ill screening for this infection, eliminating the need for further vaginal sample collection.34427227

Microbiological characteristics and inflammatory cytokines associated with preterm labor

To evaluate vaginal microflora and interleukin-1 beta (IL-beta), interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-alpha (TNF-alpha) concentrations in the cervicovaginal fluid of a group of pregnant women in preterm labor when compared with a group of full-term pregnant women not yet in labor. Case-control study performed in a University tertiary referral maternity in Campinas, Brazil with 45 pregnant women in preterm labor and 45 full-term pregnant women not in labor. All patients underwent speculum examination for the collection of cervicovaginal fluid. Bacterial vaginosis (BV) was diagnosed according to the criteria of Amsel and Nugent. Culture was performed for group B streptococcus (GBS) and lactobacilli, and hybrid capture assay for screening for chlamydial and gonococcal infection. Cytokine concentrations were measured using ELISA technique. Statistical analysis was performed using chi(2), Fisher's exact, and crude and adjusted odds ratios. Significance level was defined at 5%. The main outcome measures were cervicovaginal cytokines in preterm labor. IL-6 and IL-8 were significantly associated with preterm labor. The changes in vaginal microflora, as well as BV and GBS, were more frequent in women in preterm labor, although BV and GBS showed no statistical significance. The presence of Candida sp., absence of lactobacilli, positive screening for chlamydial and gonococcal infection and the presence of IL-1 beta and TNF-alpha were not associated with preterm labor. IL-6 and IL-8 and the presence of any type of vaginal infection were the factors that were significantly associated with preterm labor.2833501508Sao Paulo Foundatio

Increased detection of clue cells in smears from cervical intraepithelial lesions with reduced expression of COX-2

The relation between the detection of clue cells in cervical smears of women with CIN and the expression of COX-2 in these lesions were determined. Samples from 228 women, treated due to CIN and who underwent cervical conization, were obtained. Hybrid Capture II and Pap smear samples were collected immediately before performing conization. Pathological diagnoses were 11 (5%) normal cervix, 35 (15%) CINI, 31 (14%) CIN2, and 151 (66%) CIN3. COX-2 immunoreactivity grading on the pathological specimens was based on the German ImmunoReactive score. In cervical smears, 20 fields (40x) were examined, each of them with a minimum count of 10 epithelial cells. When 20% or more of clue cells were detected the sample was considered positive for clue cells. The prevalence of clue cells was similar across histological strata (P = 0.42). Although the expression of COX-2 did not differ in lesions with varying severities (P = 0.24), there was a negative association between the expression of COX-2 and the presence of clue cells in Pap smear (OR = 0.4; 95% Cl = 0.2-0.9): only 12% of women with moderate and strong expression of COX-2 had clue cells in their smears, contrasted to 22% of those with negative and weak expression of COX-2. HPV infection was associated in a borderline manner to the expression of COX-2 (P = 0.04; OR = 2.3 95% Cl = 1.0-5.4). The reduced expression of COX-2 in CIN specimens may suggest that clue cells interfere with the inflammatory component of the carcinogenic process that lead to CIN. Diagn. Cytopathol. 2008;36:705-709. (C) 2008 Wiley-Liss, Inc.361070570