A comparison of the use of Papanicolaou-stained cervical cytological smears with Gram-stained vaginal smears for the diagnosis of bacterial vaginosis in early pregnancy.

Our objective is to compare the efficacy of using Papanicolaou (PAP)-stained cervical cytology smears with a standardized method of interpreting Gram-stained vaginal smears for the diagnosis of bacterial vaginosis (BV) in pregnancy. High vaginal smears were Gram-stained and examined by a single observer to characterize 3 grades of vaginal flora and diagnose BV. Cervical smears were PAP-stained and examined for characteristic patterns of vaginal flora including evidence of BV by either a number of cytotechnicians or a single cytopathologist. The results of the 2 methods were compared. Seven hundred and forty-seven women attending an antenatal clinic in a district general hospital who consented to have a smear of vaginal secretions and cervical cytology in early pregnancy. The main outcome measure is the diagnosis of BV by different methods in a pregnant population. Compared with the Gram-stain method for the diagnosis of BV, there was good agreement between PAP-stain interpretation by a single observer but the agreement was not as good with PAP-stain interpretation by multiple cytotechnicians. When the grades were consolidated to normal (grade I) and abnormal flora (grades II and III), compared to Gram-stained smears, PAP cytology undertaken by several cytotechnicians had a sensitivity of 80.7% and a specificity of 90.7%. The sensitivity and specificity increased to 87% and 97%, respectively, when the PAP-stained smears were read by a single cytopathologist. Using kappa scores, only those readings made by a single cytopathologist were reliable. The setting in a cytopathology laboratory comprises multiple cytotechnicians, so that PAP-stain analysis of vaginal smears for the diagnosis of BV is likely to provide results which are less reliable than those obtained by Gram staining. The latter should be the first choice and every effort should be made to set up this service.

[1]  D. Taylor-Robinson,et al.  Comparison of Gram‐stained smears prepared from blind vaginal swabs with those obtained at speculum examination for the assessment of vaginal flora , 1996, British journal of obstetrics and gynaecology.

[2]  D. Taylor-Robinson,et al.  Bacterial vaginosis in pregnancy: distribution of bacterial species in different gram-stain categories of the vaginal flora. , 1996, Journal of medical microbiology.

[3]  J. Hauth,et al.  Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis , 1995, The New England journal of medicine.

[4]  P. Larsson,et al.  Detection of bacterial vaginosis in wet mount, Papanicolaou stained vaginal smears and in Gram stained smears , 1995, Acta obstetricia et gynecologica Scandinavica.

[5]  D. Taylor-Robinson,et al.  Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage , 1994, BMJ.

[6]  D. Taylor-Robinson,et al.  Diagnosis of bacterial vaginosis in a gynaecology clinic , 1992, British journal of obstetrics and gynaecology.

[7]  C. Påhlson,et al.  Incidence of pelvic inflammatory disease after first-trimester legal abortion in women with bacterial vaginosis after treatment with metronidazole: a double-blind, randomized study. , 1992, American journal of obstetrics and gynecology.

[8]  C. Påhlson,et al.  Clue Cells in Predicting Infections After Abdominal Hysterectomy , 1991, Obstetrics and gynecology.

[9]  P. Larsson,et al.  Detection of bacterial vaginosis in Papanicolaou smears. , 1989 .

[10]  J. Thomason,et al.  Proline Aminopeptidase Activity as a Rapid Diagnostic Test to Confirm Bacterial Vaginosis , 1988, Obstetrics and gynecology.

[11]  M. Lehtinen,et al.  Microbiological and histopathological findings in acute pelvic inflammatory disease , 1987, British journal of obstetrics and gynaecology.

[12]  K. Holmes,et al.  Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid , 1983, Journal of clinical microbiology.

[13]  K. Holmes,et al.  Nonspecific vaginitis: Diagnostic criteria and microbial and epidemiologic associations , 1983 .

[14]  M. Sierra,et al.  Vaginal colonization with Group B beta-hemolytic streptococcus as a risk factor for post-cesarean section febrile morbidity. , 1982, American journal of obstetrics and gynecology.

[15]  K. Holmes,et al.  Anaerobic bacteria in nonspecific vaginitis. , 1980, The New England journal of medicine.