Relationship between nugent score and vaginal epithelial exfoliation

Area of Science:

• Gynecologic Health
• Microbiology
• Cell Biology

Background:

• Bacterial vaginosis (BV) is a common vaginal dysbiosis.
• Clue cells, a hallmark of BV, are believed to result from vaginal epithelial cell exfoliation.
• Limited data exists on the direct correlation between total epithelial cell counts and BV markers.

Purpose of the Study:

• To quantify exfoliated vaginal epithelial cells, independent of clue cell identification.
• To investigate the relationship between epithelial cell exfoliation levels and Nugent scores in diagnosing BV.

Main Methods:

• A cross-sectional sub-study utilized vaginal swabs from the Contraceptive CHOICE Project cohort.
• Gram staining and Nugent scoring were performed on vaginal smears.
• Two blinded observers microscopically enumerated exfoliated epithelial cells.
• Epithelial exfoliation was compared across BV-negative (Nugent 0-3), BV-intermediate (Nugent 4-6), and BV-positive (Nugent 7-10) groups, with matching to control for demographics.

Main Results:

• Vaginal smears from BV-positive women showed significantly higher exfoliated epithelial cell counts than BV-negative women.
• BV-intermediate women also exhibited increased epithelial exfoliation compared to those with low Nugent scores.
• Adjusted incidence ratios indicated a 2.09-fold increase for BV-intermediate and 1.71-fold increase for BV-positive women.

Conclusions:

• A distinct vaginal epithelial exfoliation phenotype was observed in women with BV and intermediate BV status.
• Significantly greater vaginal epithelial exfoliation was associated with BV (Nugent >3) compared to Lactobacillus-dominated microbiotas (Nugent 0-3).