Which diagnostic tests are used in the workup of bacterial vaginosis (BV)?

Updated: Oct 25, 2018
  • Author: Philippe H Girerd, MD; Chief Editor: Michel E Rivlin, MD  more...
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Answer

FemExam [16] has been shown to have variable sensitivity (38-90%) and specificity (12.5-97%) depending on the study and study population (pre- vs postmenopausal). [17] The test provides a result in 2 minutes.

Other diagnostic tools use DNA extracted from samples of vaginal fluid using Instagene Matrix (Bio-Rad Laboratories, Hercules, CA). Results of these tests often show a difference in the bacterial components in women with BV who are postmenopausal compared with those who are premenopausal. This information is certainly helpful, particularly in treatment failures to better tailor antibiotic treatment. [17]

Table. Differential Diagnosis of the Vaginitides (Open Table in a new window)

Clinical Elements

Bacterial Vaginosis

Trichomoniasis

Vaginal Candidiasis

Symptoms

Vaginal odor

+

+/-

-

Vaginal discharge

Thin, gray, homogenous

Green-yellow

White, curdlike

Vulvar irritation

+/-

+

+

Dyspareunia

-

+

-

Signs

Vulvar erythema

-

+/-

+/-

Bubbles in vaginal fluid

+

+/-

-

Strawberry cervix

-

+/-

-

Microscopy

Saline wet mount

Clue cells

+

-

-

Motile protozoa

-

+

-

KOH test

Pseudohyphae

-

-

+

Whiff test

+

+/-

-

pH

>4.5

>4.5

< 4.5


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