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Published on: October 23, 2011
The papanicolaou smear: inadequate screening test for bacterial vaginosis during pregnancy
J F Greene1, T J Kuehl, S R Allen
1Departments of Obstetrics and Gynecology, Scott and White Memorial Hospital and Clinic, Texas A&M University Health Sciences Center College of Medicine, Temple 76508, USA.
Objective:
Our purpose was to evaluate the ability of the Papanicolaou smear to identify bacterial vaginosis in comparison with the Amsel clinical criteria.
Study Design:
We retrospectively identified 159 pregnant women screened for bacterial vaginosis with the Amsel criteria who had a contemporaneous Papanicolaou smear and negative results on screening for Chlamydia trachomatis and Neisseria gonorrhoeae. Bacterial vaginosis was identified in 45 women. We used the McNemar chi(2) test to determine discrepancies between the two screening methods for the detection of bacterial vaginosis.
Results:
Compared with the Amsel criteria, the sensitivity and specificity of the Papanicolaou smear for yielding a diagnosis of bacterial vaginosis were 49% (95% confidence interval, 36%-64%) and 93% (95% confidence interval, 86%-97%), respectively, with a positive predictive value of 73% and a negative predictive value of 82%. The detection of bacterial vaginosis by Papanicolaou smear was significantly different from that by Amsel criteria (P =. 01).
Conclusion:
The Papanicolaou smear is not a reliable screening test for bacterial vaginosis during pregnancy.
Insights
The Papanicolaou smear is not a reliable screening tool for bacterial vaginosis in pregnant women. Its low sensitivity means it frequently misses cases, making it unsuitable for routine screening during pregnancy.
Area of Science:
- Obstetrics and Gynecology
- Microbiology
- Diagnostic Accuracy
Background:
- Bacterial vaginosis (BV) is a common vaginal condition in pregnancy.
- Accurate screening for BV is crucial to prevent adverse pregnancy outcomes.
- The Papanicolaou smear is a widely used cytological test.
Purpose of the Study:
- To compare the diagnostic accuracy of the Papanicolaou smear with the Amsel clinical criteria for identifying bacterial vaginosis in pregnant women.
Main Methods:
- Retrospective analysis of 159 pregnant women screened for BV using Amsel criteria.
- Comparison of Papanicolaou smear results with Amsel criteria diagnosis.
- Statistical analysis using McNemar chi(2) test to assess discrepancies.
Main Results:
- Papanicolaou smear demonstrated a sensitivity of 49% and specificity of 93% for BV detection compared to Amsel criteria.
- Positive predictive value was 73% and negative predictive value was 82%.
- Significant differences were observed between the two screening methods (P = .01).
Conclusions:
- The Papanicolaou smear is unreliable for screening bacterial vaginosis during pregnancy.
- Its low sensitivity limits its utility as a primary diagnostic tool for BV in this population.
