Nugent score

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Nugent score
Purposediagnose bacterial vaginosis

The Nugent Score is a Gram stain scoring system for vaginal swabs to diagnose bacterial vaginosis (BV). The Nugent score is calculated by assessing for the presence of large Gram-positive rods ( Lactobacillus morphotypes; decrease in Lactobacillus scored as 0 to 4), small Gram-variable rods (Gardnerella vaginalis morphotypes; scored as 0 to 4), and curved Gram-variable rods (Mobiluncus spp. morphotypes; scored as 0 to 2). A score of 7 to 10 is consistent with bacterial vaginosis without culture. The Nugent Score is now rarely used by physicians due to the time it takes to read the slides and requires the use of a trained microscopist. [1] Bacterial vaginosis diagnosis is done by evaluating the pH, the presences of Lactobacillus spp. versus a mixed flora consisting of Gardnerella vaginalis, Bacteroides spp, Mobiluncus spp, and Mycoplasma hominis. The Amsel Criteria for bacterial vaginosis includes pH, evaluating the presence of clue cells, white discharge and an odor of amines after mixing with KOH. [2]

Contents

Scoring

Prior to the development of Nugent score, assessment of bacterial vaginosis was based on culturing G. vaginalis, examining a gram stain of vaginal discharge and gas chromatography. [3]

A score of 0-10 is generated from combining three other scores. The scores are as follows: [3]

At least 10–20 high power (1000× oil immersion) fields are counted and an average determined.

Lactobacillus morphotypes — average per high powered (1000× oil immersion) field. View multiple fields.

Gardnerella / Bacteroides morphotypes — average per high powered (1000× oil immersion) field. View multiple fields.

Curved Gram variable rods — average per high powered (1000× oil immersion) field. View multiple fields (note that this factor is less important — scores of only 0–2 are possible)

  • Score 0 for >30
  • Score 1 for 5–30
  • Score 2 for 1-4
  • Score 3 for < 1 (this is an average, so results can be >0, yet <1)
  • Score 4 for 0
  • Score 0 for 0
  • Score 1 for <1 (this is an average, so results can be >0, yet <1)
  • Score 2 for 1–4
  • Score 3 for 5–30
  • Score 4 for > 30
  • Score 0 for 0
  • Score 1 for 1-4
  • Score 2 for >= 5

The scoring system was proposed by Robert P Nugent in 1991. In the study, vaginal swabs were obtained from pregnant women. [3]

Related Research Articles

<span class="mw-page-title-main">Bacterial vaginosis</span> Excessive growth of bacteria in the vagina

Bacterial vaginosis (BV) is an infection of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally, there may be no symptoms. Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

Nongonococcal urethritis (NGU) is inflammation of the urethra that is not caused by gonorrheal infection.

<i>Gardnerella vaginalis</i> Species of bacterium

Gardnerella vaginalis is a species of Gram-variable-staining facultative anaerobic bacteria. The organisms are small non-spore-forming, nonmotile coccobacilli.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Cervicitis</span> Inflammation of the uterine cervix

Cervicitis is inflammation of the uterine cervix. Cervicitis in women has many features in common with urethritis in men and many cases are caused by sexually transmitted infections. Non-infectious causes of cervicitis can include intrauterine devices, contraceptive diaphragms, and allergic reactions to spermicides or latex condoms. Cervicitis affects over half of all women during their adult life.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

<span class="mw-page-title-main">Clue cell</span> Epithelial cell of the human vagina that is covered with bacteria

Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria. The etymology behind the term "clue" cell derives from the original research article from Gardner and Dukes describing the characteristic cells. The name was chosen for its brevity in describing the sine qua non of bacterial vaginosis.

Levilactobacillus brevis is a gram-positive, rod shaped species of lactic acid bacteria which is heterofermentative, creating CO2, lactic acid and acetic acid or ethanol during fermentation. L. brevis is the type species of the genus Levilactobacillus (previously L. brevis group), which comprises 24 species. It can be found in many different environments, such as fermented foods, and as normal microbiota. L. brevis is found in food such as sauerkraut and pickles. It is also one of the most common causes of beer spoilage. Ingestion has been shown to improve human immune function, and it has been patented several times. Normal gut microbiota L. brevis is found in human intestines, vagina, and feces.

<span class="mw-page-title-main">Vaginal flora</span> Microorganisms present in the vagina

Vaginal flora, vaginal microbiota or vaginal microbiome are the microorganisms that colonize the vagina. They were discovered by the German gynecologist Albert Döderlein in 1892 and are part of the overall human flora. The amount and type of bacteria present have significant implications for an individual's overall health. The primary colonizing bacteria of a healthy individual are of the genus Lactobacillus, such as L. crispatus, and the lactic acid they produce is thought to protect against infection by pathogenic species.

Mobiluncus is a genus of Gram-positive, anaerobic, rod-shaped bacteria. These bacteria may be stained either Gram-negative or Gram-variable. However, they are classified as Gram-positive rods due to the fact that they possess a Gram-positive cell wall, lack endotoxin and are sensitive to vancomycin, erythromycin and ampicillin, but resistant to colistin.

Prevotella is a genus of Gram-negative bacteria.

<span class="mw-page-title-main">Vaginal wet mount</span> Gynecologic test

A vaginal wet mount is a gynecologic test wherein a sample of vaginal discharge is observed by wet mount microscopy by placing the specimen on a glass slide and mixing with a salt solution. It is used to find the cause of vaginitis and vulvitis.

<span class="mw-page-title-main">High vaginal swab</span> Medical procedure

A high vaginal swab (HVS) is a medical procedure performed in obstetrics and gynaecology to test vaginal discharge for the presence of vaginal thrush, bacterial vaginosis and trichomonas vaginalis.

Lactobacillus crispatus is a common, rod-shaped species of genus Lactobacillus and is a hydrogen peroxide (H2O2) producing beneficial microbiota species located in both the vagina, through vaginal discharge, and the vertebrate gastrointestinal tract. The strain CTV-05 is used as a probiotic that can be used by premenopausal and postmenopausal women that experience recurrent urinary tract infections. It is being evaluated specifically for the prevention and treatment of bacterial vaginosis, which is characterized by the absence of Lactobacillus flora necessary to protect the host from infection.

The vaginal flora in pregnancy, or vaginal microbiota in pregnancy, is different from the vaginal flora before sexual maturity, during reproductive years, and after menopause. A description of the vaginal flora of pregnant women who are immunocompromised is not covered in this article. The composition of the vaginal flora significantly differs in pregnancy. Bacteria or viruses that are infectious most often have no symptoms.

Lactobacillus jensenii is a normal inhabitant of the lower reproductive tract in healthy women. L. jensenii makes up 23% of vaginal microflora that is naturally occurring. It is also found on the skins of grapes at the time of their harvest. L. jensenii is sometimes used in producing fermented foods.

Sharon Louise Hillier is an American microbiologist. She is the Richard Sweet Endowed Chair in Reproductive Infectious Disease and vice chair of the department of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh Medical Center (UPMC) and Magee-Women's Research Institute.

<span class="mw-page-title-main">Lactobacillus vaccine</span> Vaccine using an inactivated strain of Lactobacillus

Lactobacillus vaccines are used in the therapy and prophylaxis of non-specific bacterial vaginitis and trichomoniasis. The vaccines consist of specific inactivated strains of Lactobacilli, called "aberrant" strains in the relevant literature dating from the 1980s. These strains were isolated from the vaginal secretions of patients with acute colpitis. The lactobacilli in question are polymorphic, often shortened or coccoid in shape and do not produce an acidic, anti-pathogenic vaginal environment. A colonization with aberrant lactobacilli has been associated with an increased susceptibility to vaginal infections and a high rate of relapse following antimicrobial treatment. Intramuscular administration of inactivated aberrant lactobacilli provokes a humoral immune response. The production of specific antibodies both in serum and in the vaginal secretion has been demonstrated. As a result of the immune stimulation, the abnormal lactobacilli are inhibited, the population of normal, rod-shaped lactobacilli can grow and exert its defense functions against pathogenic microorganisms.

References

  1. Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN   9781455748013;
  2. Colonna, Caitlin; Steelman, Michael (July 13, 2020). "Amsel Criteria". Pubmed. PMID   31194459 . Retrieved October 7, 2020.
  3. 1 2 3 Nugent, R P; Krohn, M A; Hillier, S L (February 1991). "Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation". Journal of Clinical Microbiology. 29 (2): 297–301. doi:10.1128/JCM.29.2.297-301.1991. ISSN   0095-1137. PMC   269757 . PMID   1706728.