Routine Pap smears for the diagnosis of bacterial vaginosis

This study investigated the role of Papanicolaou (Pap) smears in determining the presence of bacterial vaginosis (BV). Pap results, vaginal Gram stains, signs, symptoms, and wet mounts were evaluated. Vaginal smears for Gram stain and routine Pap smears were collected from 420 consecutive patients. Ninety-three percent of patients with Pap smears showing only coccobacilli had a corresponding BV-positive Gram stain. Pap smears with mixed bacterial patterns had 22-71% positive Gram stains depending on the types of bacteria present. Only 10 of 70 symptomatic patients and 13 of 132 with cervicitis or discharge had a positive Gram stain and/or an altered bacterial pattern. All positive wet mounts had positive Gram stains and coccobacilli only on Pap smears. The most specific diagnosis of BV with Pap smears requires coccobacilli only. This reiterates the Bethesda system criteria. Clinical signs, physical symptoms, and wet-mount examinations were noncontributory in this study.