IN PRACTICE

Methods employed by genitourinary medicine clinics in the United Kingdom to diagnose bacterial vaginosis

F E A Keane¹, R Maw², C Pritchard³ and C A Ison⁴

¹ Department of Genito-urinary Medicine, Royal Cornwall Hospital, Truro, UK
² Department of Genito-urinary Medicine, Royal Victoria Hospital, Belfast, UK
³ Research and Development Support Unit, Royal Cornwall Hospital, Truro, UK
⁴ Department of Infectious Diseases and Microbiology, Imperial College London, St Mary’s Campus, London, UK

Correspondence to:
Correspondence to:
Dr Frances Keane
Department of Genitourinary Medicine, Royal Cornwall Hospital, Treliske, Truro TR1 3LJ, UK; keanefr{at}rcht.cornwall.nhs,uk

Objective: To determine the methods used by genitourinary medicine (GUM) clinics in the United Kingdom for the diagnosis of bacterial vaginosis (BV).

Methods: A questionnaire survey of UK GUM clinics was conducted.

Results: 148/221 (67%) clinics returned a questionnaire. 96/148 (64.9%) clinics reported using Amsel’s criteria to diagnose BV but only 29 (30.5%) of these used all four of the composite criteria. 139/148 (93.9%) clinics used the appearance of a Gram stained vaginal smear as an aid in BV diagnosis, although a variety of scoring methods was employed. In the majority of clinics, 92/148 (62.2%), one staff discipline provided the microscopy service, in 50 (33.8%) clinics two staff disciplines provided microscopy services. The bulk of microscopy services within UK GUM clinics is provided by nurses.

Conclusions: Most UK GUM clinics utilise the appearance of a Gram stained vaginal smear for the diagnosis of BV although there is little consensus at present about the type of scoring method employed. Adaptation of a uniform scoring method would have enormous benefits, including consistency and reproducibility of results and the development of quality assurance schemes for BV diagnosis on a national basis. There are important issues to be addressed regarding the initial training and ongoing support for nurses providing microscopy services within UK GUM clinics.

Abbreviations: BV, bacterial vaginosis; GUM, genitourinary medicine; MLSOs, medical laboratory scientific officers

Keywords: bacterial vaginosis; Gram stained smears; scoring systems

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