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NJBMS - Volume 8, Issue 1, July - September 2017

Pages: 21-26
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Interobserver Agreement in the Interpretation of Nugent Scoring Method for Diagnosis of Bacterial Vaginosis in a Tertiary Care Hospital in South India

Author: Sasikala.G, Kavitha.A, Mathavi.S, Lavanya Devi, Indra Priyadharsini.R

Category: Microbiology


Background : Bacterial vaginosis is one of the most common causes of abnormal vaginal discharge in women of reproductive age. Diagnosis is confirmed clinically using Amsel's criteria which vary from patient to patient. Thus, grading the Gram-stained vaginal smears, using a criteria proposed by Nugent et al is used for diagnosis of BV.

Aim and Objectives : To examine interobserver agreement on interpretation of Nugent scoring method in the diagnosis of Bacterial vaginosis in a tertiary care hospital in south India.

Materials and methods: This prospective study was conducted in a tertiary care hospital in South India from January to June 2013. After getting informed consent and ethical committee approval, high vaginal swabs collected from 220 married, sexually active symptomatic women between 18-49 yrs were subjected to Gram stain and Nugent's scoring done by 3 independent qualified microbiologists. The results were graded as 0-3 (normal), 4-6 (intermediate) and 7-10 (bacterial vaginosis) independently by each observer and compared by ANOVA statistical analysis.

Results: Complete agreement was obtained for 168 slides by all three examiners. The prevalence of Bacterial vaginosis in our population was 14.5%. The inter-observer reproducibility of Nugent score was excellent in this study (76%). Since the interpretation of Gram-stained smears correlate with the clinical diagnosis and high level of interobserver agreement has been demonstrated and statistically significant, we believe the Gram-stained smear alone, without culture, can be used to evaluate vaginal swabs for bacterial vaginosis

Conclusion: Nugent scoring system appears to be a reliable and convenient method for laboratory evaluation of bacterial vaginosis.

Keywords: Bacterial vaginosis, Nugent's scoring, Amsel's criteria, interobserver agreement.