Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay

Resumen

Worldwide, vaginal infection is the commonest cause for seeking medical advice for genital symptoms and has obstetric and gynecological implications. We aimed to compare the Nugent and Spiegel methods for diagnosing bacterial vaginosis (BV) and to analyze discordant specimens by using the criteria of Ison and Hay (Ison/Hay). The records of Gram-stained smears of all vaginal specimens received between 2006 and 2009 for diagnosis of BV was reviewed, a total of 369 specimens. After discarding Candidiasis cases, deficient specimens or those lacking bacteria, a total of 348 specimens were analyzed. The frequency of normal and BV as determined by Nugent and Spiegel criteria were 58.3%, 30.2%, and 68.1%, 31.9%, respectively. The results of 308/ 348 (88.5%) specimens were concordant. The 40 (11.5%) discordant specimens were classified as intermediate microflora by the Nugent system and as normal or BV by Spiegel, but four categories of microbiota were found inside this group by the Ison/Hay procedure. Ten (25%) of these specimens were classified as grade II microbiota, confirming their categorization by Nugent as intermediate microbiota, 6 (15%) were classified in the III category, confirming the diagnosis of BV by Spiegel, 13(32.5%) corresponded to the category III, not existing in the Nugent and Spiegel categorization systems, and 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. In conclusion, the Spiegel procedure   is a good method for diagnosing BV, but unlike the Nugent and Ison/Hay systems it lacks the intermediate category. The evaluation system of Ison /Hay may have a better capability to diagnose and discriminate the vaginal microbiota.