The presence of various amines in vaginal fluid from women with malodorous vaginal discharge has been reported before. The investigations have used several techniques to identify the amines. However, an optimized quantification, together with a sensitive analysis method in connection with a diagnostic procedure for vaginal discharge, including the syndrome of bacterial vaginosis, as defined by the accepted "gold standard," has not been done before. We now report a sensitive gas chromatographic and mass spectrometric method for identifying the amines isobutylamine, phenethylamine, putrescine, cadaverine, and tyramine in vaginal fluid. We used weighted samples of vaginal fluid to obtain a correct quantification. In addition, a proper diagnosis was obtained using Bacterial vaginosis (BV) commonly occurs in women of childbearing age. Prevalences of 10 to 31% have been reported in various populations (7). Several investigations have been performed to identify one or several bacteria comprising the decisive pathogenic factor in the syndrome, but so far no specific bacteria have been implicated in causing BV. Rather, it seems that BV is accompanied by a shift in the normal lactobacillus flora to a mixed vaginal anaerobic flora including Gardnerella vaginalis, Bacteroides spp., and Mobiluncus spp. (for a review, see reference 18). The importance of BV with respect to women's health is emphasized by the association between BV and pelvic inflammatory diseases, adverse outcome of pregnancy, postpartum endometritis, and cuff cellulitis (8,12,14,15).Amsel et al.(1) proposed a set of practical diagnostic criteria for the clinical diagnosis of BV that is now often accepted as the "gold standard." Three of the four criteria, i.e., a vaginal pH of Ͼ4.5, the presence of an adherent white discharge, a fishy amine odor after addition of KOH, and clue cells, must be met for the diagnosis of BV. A scoring system based on microscopically detectable changes in vaginal fluid is now also commonly used; Gram-stained vaginal smears and wet-mount smears in particular are well documented for use in BV diagnostics (11, 13). Several other alternative methods have also been used to develop easy, inexpensive, and reproducible diagnostic methods such as the rapid nucleic acid hybridization test (5), proline aminopeptidase activity (20), and the amine test (17).The syndrome of BV as defined by Amsel's clinical criteria seems to be a well-defined polythetic concept of major importance to women's health. Consequently, it is important to describe the most important dimensions that can be of use in women's health care. One dimension is the increased numbers of anaerobic bacteria in the vagina that lead to the characteristic amine production and odor. Amine production is thus an important property of the concept of BV and is clearly related to scoring with Amsel's criteria or Nugent scores. Production of amines is a property of several anaerobic bacterial species occurring in the human vagina, and these amines are released into the vaginal fluid in BV ...

The presence of a fishy odor emanating from women who present with a malodorous vaginal discharge is well known. The odor is due to bacterial reduction of trimethylamine oxide to trimethylamine (TMA) in vaginal secretion. The release of TMA from specimens of vaginal fluid following the addition of alkali is often used in making a clinical diagnosis of bacterial vaginosis (BV). We now report a sensitive gas chromatographic method for analysis and quantification of TMA in vaginal fluid in which weighed samples were used. In addition, a proper diagnosis of BV was obtained using Gram-stained smears of the vaginal fluid according to the method of Nugent et al. (R. P. Nugent et al., J Clin Microbiol 1991;29:297-301). We also diagnosed BV according to Hallén et al. (A. Hallén et al. Genitourin Med 1987;63:386-9). TMA was present in all women with a Nugent score between 7 and 10 and in almost all women diagnosed with BV according to the method of Hallén et al. TMA was not found or was only found in very low concentrations in vaginal fluid from women with Nugent scores of 0 to 3. TMA was also found in four women with a negative sniff test. It seems that high levels of TMA in samples of vaginal fluid are typical for BV regardless of the scoring method used for diagnosis. However, low levels of TMA, <5 microg/g vaginal fluid, do not always correlate with BV.

The smell of rotten fish is one of the characteristics of bacterial vaginosis (BV), and is due to trimethylamine (TMA). Trimethylamine can be found in human urine, although most of it occurs as the nonvolatile oxide (TMAO) form. The fraction TMA/TMAO can be expected to be the same in different body fluids if no local production of TMA occurs. In women with BV, TMAO in the vaginal fluid is expected to be chemically reduced by the local bacterial flora to the much more odorous TMA. We have therefore studied the local vaginal production of TMA in vaginal secretion compared to the general TMA-TMAO metabolism that was measured in urine using gas chromatography. Both vaginal fluid and random urine samples were collected from women, with and without BV, attending a Swedish clinic for sexually transmitted diseases, and these samples were analyzed for TMA and TMAO. The results show that a local production of TMA occurs in the vagina that is not part of the general metabolism of TMA-TMAO.

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