Comparison between Nugent's and Hay/Ison scoring criteria for the diagnosis of Bacterial Vaginosis in WASP prepared vaginal samples

Abstract

Background: The aim of this study was to compare two different Bacterial Vaginosis diagnosis criteria, Nugent's score system and Hay/Ison criterion, by using Gram-stained vaginal smears. Materials and findings:Gram-stained smears were prepared with 10 µl and 30 µl of 100 vaginal samples, collected in ESwab ® , by the WASP ® automatic system. All smears were examined at 1000X magnification and assessed using both Nugent and Hay/Ison criteria. In addition, the presence of clue cells was recorded. All the slides were assessed by three independent expert readers in a blinded manner. Conclusions:The Hay/Ison criterion is a credible alternative to the Nugent's score system for the diagnosis of Bacterial Vaginosis. Furthermore, the combination of WASP ® automatic system and the Hay/Ison criterion can represent a fast and reliable workflow, especially in those laboratories where the request of vaginal culture tests is extremely high.

Bacterial Vaginosis: What Do We Currently Know?

“…In fact, intermediate flora is so far an uncharacterized category and is a challenge in the diagnosis of BV. In addition, the identification of morphotypes is subjective and technician-dependent, thus the diagnosis may be influenced by individual skills and experience ( Menard et al., 2008 ; Antonucci et al., 2017 ).…”

Bacterial Vaginosis: Current Diagnostic Avenues and Future Opportunities

“…Clinical laboratories identify changes in the vaginal environment through microscopic examination and vaginal swab culture (Hong et al, 2016 ). Nugent scoring involves Gram-staining of vaginal smears and has been suggested as the gold standard in the diagnosis of BV in comparison to Amsel's criteria, which is based on non-quantifiable, non-reproducible clinical symptoms only (Chawla et al, 2013 ; Amegashie et al, 2017 ; Antonucci et al, 2017 ; Coleman and Gaydos, 2018 ). The diagnosis of BV is made on quantification of the Gram-stained microorganisms, classifying these organisms based on different vaginal morphotypes as well as the identification of clue cells (part of the Amsel's criteria) which could be laborious and requiresskilled personnel (Nugent et al, 1991 ; Chawla et al, 2013 ; Antonucci et al, 2017 ).…”

“…morphotypes (Ison and Hay, 2002 ; Chawla et al, 2013 ). A vaginal microflora with a Nugent score of 4 to 6, known as an intermediate score or intermediate microflora is classified in grade II by the Ison-Hay criteria (Amegashie et al, 2017 ; Antonucci et al, 2017 ). An intermediate microflora was initially thought as a transitional step between a normal vaginal microflora and BV, or vice versa , but remains an uncharacterized category and is a challenge in the diagnosis of BV due to unknown clinical implications (Verhelst et al, 2005 ; Menard et al, 2008 ).…”

“…An intermediate microflora was initially thought as a transitional step between a normal vaginal microflora and BV, or vice versa , but remains an uncharacterized category and is a challenge in the diagnosis of BV due to unknown clinical implications (Verhelst et al, 2005 ; Menard et al, 2008 ). Microscopy may be desired by some clinicians above other laboratory tests such as molecular assays due to a shorter turn-around time; however, the identification of different morphotypes is subjective and diagnosis may be influenced by individual skills and experience (Chawla et al, 2013 ; Antonucci et al, 2017 ). The involvement of species such as A. vaginae, Ureaplasma spp.…”

Finding a Balance in the Vaginal Microbiome: How Do We Treat and Prevent the Occurrence of Bacterial Vaginosis?

“…A team in Italy also suggested the potential of automation using the WASP ® automatic system (BioMérieux diagnostics) to analyze samples collected in LMB ESwab ® (BioMérieux diagnostics). The introduction of advanced technology helps increase reliability and shorten sampling time while ensuring timely diagnosis and treatment [186]. * Lactobacillus spp.…”