Accuracy of clinical diagnosis of bacterial vaginosis by human immunodeficiency virus infection status

Maria F. Gallo, Denise J. Jamieson, Susan Cu-Uvin, Anne Marie Rompalo, Robert S. Klein, Jack D. Sobel

Research output: Contribution to journalArticle

Abstract

Objective: To assess the accuracy of clinical diagnosis of bacterial vaginosis (BV) by using Amsel criteria, overall and by human immunodeficiency virus (HIV) infection status. Methods: Women with HIV, or at risk for HIV, participated in the HIV Epidemiology Research Study, a prospective study conducted in 4 US sites. At enrollment and follow-up visits, scheduled at 6-month intervals for ≤5 years, participants received gynecologic examinations, had specimens collected, and underwent standardized interviews. We used McNemar test statistic to evaluate agreement between Amsel criteria and Nugent scoring. Using Nugent scoring as the reference standard, we calculated sensitivity and specificity for Amsel criteria and for 3 other classifications of clinical BV. Our results are based on data collected from 9140 study visits by 862 HIV-infected women and 421 HIV-uninfected women. Results: Amsel criteria and Nugent scoring did not agree in the classification of BV cases (P <0.01). Amsel criteria had poor sensitivity (60%; 95% confidence interval, 58%-61%) and specificity (90%; 95% confidence interval, 89%-91%) with wide differences in test properties by study site. We found no differences in diagnosing BV by HIV infection status. Conclusions: The under- and overdiagnosing of BV clinically suggests that the accuracy of Amsel criteria for routine screening of asymptomatic women might be lower than previous estimates; that clinicians need more rigorous training to apply subjective Amsel criteria accurately; or that wide heterogeneity in cases might prevent agreement between clinical and laboratory diagnoses, with future research needed to better understand the criteria or morphotypes associated with specific adverse outcomes.

Original languageEnglish (US)
Pages (from-to)270-274
Number of pages5
JournalSexually Transmitted Diseases
Volume38
Issue number4
DOIs
StatePublished - Apr 2011

Fingerprint

Bacterial Vaginosis
Virus Diseases
HIV
Confidence Intervals
Clinical Laboratory Techniques
Epidemiology
Prospective Studies
Interviews
Sensitivity and Specificity
Research

ASJC Scopus subject areas

  • Dermatology
  • Public Health, Environmental and Occupational Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Accuracy of clinical diagnosis of bacterial vaginosis by human immunodeficiency virus infection status. / Gallo, Maria F.; Jamieson, Denise J.; Cu-Uvin, Susan; Rompalo, Anne Marie; Klein, Robert S.; Sobel, Jack D.

In: Sexually Transmitted Diseases, Vol. 38, No. 4, 04.2011, p. 270-274.

Research output: Contribution to journalArticle

Gallo, Maria F. ; Jamieson, Denise J. ; Cu-Uvin, Susan ; Rompalo, Anne Marie ; Klein, Robert S. ; Sobel, Jack D. / Accuracy of clinical diagnosis of bacterial vaginosis by human immunodeficiency virus infection status. In: Sexually Transmitted Diseases. 2011 ; Vol. 38, No. 4. pp. 270-274.
@article{7236c13684ad4329aa9956e1ca8e22bf,
title = "Accuracy of clinical diagnosis of bacterial vaginosis by human immunodeficiency virus infection status",
abstract = "Objective: To assess the accuracy of clinical diagnosis of bacterial vaginosis (BV) by using Amsel criteria, overall and by human immunodeficiency virus (HIV) infection status. Methods: Women with HIV, or at risk for HIV, participated in the HIV Epidemiology Research Study, a prospective study conducted in 4 US sites. At enrollment and follow-up visits, scheduled at 6-month intervals for ≤5 years, participants received gynecologic examinations, had specimens collected, and underwent standardized interviews. We used McNemar test statistic to evaluate agreement between Amsel criteria and Nugent scoring. Using Nugent scoring as the reference standard, we calculated sensitivity and specificity for Amsel criteria and for 3 other classifications of clinical BV. Our results are based on data collected from 9140 study visits by 862 HIV-infected women and 421 HIV-uninfected women. Results: Amsel criteria and Nugent scoring did not agree in the classification of BV cases (P <0.01). Amsel criteria had poor sensitivity (60{\%}; 95{\%} confidence interval, 58{\%}-61{\%}) and specificity (90{\%}; 95{\%} confidence interval, 89{\%}-91{\%}) with wide differences in test properties by study site. We found no differences in diagnosing BV by HIV infection status. Conclusions: The under- and overdiagnosing of BV clinically suggests that the accuracy of Amsel criteria for routine screening of asymptomatic women might be lower than previous estimates; that clinicians need more rigorous training to apply subjective Amsel criteria accurately; or that wide heterogeneity in cases might prevent agreement between clinical and laboratory diagnoses, with future research needed to better understand the criteria or morphotypes associated with specific adverse outcomes.",
author = "Gallo, {Maria F.} and Jamieson, {Denise J.} and Susan Cu-Uvin and Rompalo, {Anne Marie} and Klein, {Robert S.} and Sobel, {Jack D.}",
year = "2011",
month = "4",
doi = "10.1097/OLQ.0b013e3181fce4eb",
language = "English (US)",
volume = "38",
pages = "270--274",
journal = "Sexually Transmitted Diseases",
issn = "0148-5717",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Accuracy of clinical diagnosis of bacterial vaginosis by human immunodeficiency virus infection status

AU - Gallo, Maria F.

AU - Jamieson, Denise J.

AU - Cu-Uvin, Susan

AU - Rompalo, Anne Marie

AU - Klein, Robert S.

AU - Sobel, Jack D.

PY - 2011/4

Y1 - 2011/4

N2 - Objective: To assess the accuracy of clinical diagnosis of bacterial vaginosis (BV) by using Amsel criteria, overall and by human immunodeficiency virus (HIV) infection status. Methods: Women with HIV, or at risk for HIV, participated in the HIV Epidemiology Research Study, a prospective study conducted in 4 US sites. At enrollment and follow-up visits, scheduled at 6-month intervals for ≤5 years, participants received gynecologic examinations, had specimens collected, and underwent standardized interviews. We used McNemar test statistic to evaluate agreement between Amsel criteria and Nugent scoring. Using Nugent scoring as the reference standard, we calculated sensitivity and specificity for Amsel criteria and for 3 other classifications of clinical BV. Our results are based on data collected from 9140 study visits by 862 HIV-infected women and 421 HIV-uninfected women. Results: Amsel criteria and Nugent scoring did not agree in the classification of BV cases (P <0.01). Amsel criteria had poor sensitivity (60%; 95% confidence interval, 58%-61%) and specificity (90%; 95% confidence interval, 89%-91%) with wide differences in test properties by study site. We found no differences in diagnosing BV by HIV infection status. Conclusions: The under- and overdiagnosing of BV clinically suggests that the accuracy of Amsel criteria for routine screening of asymptomatic women might be lower than previous estimates; that clinicians need more rigorous training to apply subjective Amsel criteria accurately; or that wide heterogeneity in cases might prevent agreement between clinical and laboratory diagnoses, with future research needed to better understand the criteria or morphotypes associated with specific adverse outcomes.

AB - Objective: To assess the accuracy of clinical diagnosis of bacterial vaginosis (BV) by using Amsel criteria, overall and by human immunodeficiency virus (HIV) infection status. Methods: Women with HIV, or at risk for HIV, participated in the HIV Epidemiology Research Study, a prospective study conducted in 4 US sites. At enrollment and follow-up visits, scheduled at 6-month intervals for ≤5 years, participants received gynecologic examinations, had specimens collected, and underwent standardized interviews. We used McNemar test statistic to evaluate agreement between Amsel criteria and Nugent scoring. Using Nugent scoring as the reference standard, we calculated sensitivity and specificity for Amsel criteria and for 3 other classifications of clinical BV. Our results are based on data collected from 9140 study visits by 862 HIV-infected women and 421 HIV-uninfected women. Results: Amsel criteria and Nugent scoring did not agree in the classification of BV cases (P <0.01). Amsel criteria had poor sensitivity (60%; 95% confidence interval, 58%-61%) and specificity (90%; 95% confidence interval, 89%-91%) with wide differences in test properties by study site. We found no differences in diagnosing BV by HIV infection status. Conclusions: The under- and overdiagnosing of BV clinically suggests that the accuracy of Amsel criteria for routine screening of asymptomatic women might be lower than previous estimates; that clinicians need more rigorous training to apply subjective Amsel criteria accurately; or that wide heterogeneity in cases might prevent agreement between clinical and laboratory diagnoses, with future research needed to better understand the criteria or morphotypes associated with specific adverse outcomes.

UR - http://www.scopus.com/inward/record.url?scp=79953205890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953205890&partnerID=8YFLogxK

U2 - 10.1097/OLQ.0b013e3181fce4eb

DO - 10.1097/OLQ.0b013e3181fce4eb

M3 - Article

C2 - 21042232

AN - SCOPUS:79953205890

VL - 38

SP - 270

EP - 274

JO - Sexually Transmitted Diseases

JF - Sexually Transmitted Diseases

SN - 0148-5717

IS - 4

ER -