A 25-year-old female patient presents with fishy odour vaginal discharge. Pap Smear shows the following picture. What can be the most possible diagnosis?
Ans. is B. i.e. Bacterial Vaginosis.
- Indicator cells also known as “Clue Cells” form the characteristic picture of BV.
- Note the presence of multiple microorganisms, which are attached to a single squamous epithelial cell.
Investigations for bacterial vaginosis:
- IOC -Saline microscopy ‘Clue cells’, i.e. vaginal epithelial cells to which bacteria have adhered is seen.
- The gold standard investigation is a Gram stain.
- On gram staining -Nugent scoring is done.
- The Nugent score is calculated by assessing the Presence of lactobacillus (Gram +ve rods-scored as 0 to 4), Gardnerella vaginalis (scored as 0 to 4) and mobiluncus (Gram variable rods-scored as 0-2).
- A score of > 7 is consistent with bacterial vaginosis.
- Hanging drop examination—Reveals the presence of motile trichomonas organisms.
- KOH treated preparation of vaginal discharge—Reveals the presence of pseudomycelia and spores of candidal organisms.
- pH > 4.5
- Whiff test—The fishy odour is suggestive of the presence of bacterial vaginosis.
- Positive amine test.