I am an OBGYN resident, and this video is intended to briefly review Amsel Criteria, used for the diagnosis of bacterial vaginosis. This video is intended for medical students, residents, and fellows. Please enjoy!

The Amsel criteria consist of the following four components:

Thin, white, homogeneous discharge: BV is associated with a characteristic discharge that is typically thin, white or gray in color, and has a homogeneous appearance. This discharge often has a distinct odor, described as fishy or foul-smelling.

Positive "whiff test": The whiff test involves adding a small amount of potassium hydroxide (KOH) solution to the vaginal discharge. If a fishy odor becomes more pronounced, it is considered a positive result and indicative of BV.

Elevated vaginal pH: BV is associated with an increase in vaginal pH, which can be measured using a pH indicator strip. A pH level higher than 4.5 is considered abnormal and suggests the presence of BV.

Presence of clue cells on microscopy: Clue cells are vaginal epithelial cells covered with small, adherent bacteria. These cells can be visualized under a microscope, and their presence is a strong indicator of BV.

To diagnose BV using the Amsel criteria, a patient must meet at least three of the above criteria. If a resident observes three or more positive findings, they can confidently diagnose the patient with bacterial vaginosis. It is important to note that the Amsel criteria are often used in combination with additional tests, such as microscopic examination or laboratory cultures, to confirm the diagnosis and rule out other possible vaginal infections.

Bacterial vaginosis (BV) is a common vaginal infection that primarily affects women of reproductive age. It is characterized by an imbalance in the vaginal microbiota, where there is a decrease in the beneficial lactobacilli bacteria and an overgrowth of other bacteria, particularly anaerobic species.

The exact cause of BV is not fully understood, but it is believed to result from multiple factors, including sexual activity, hormonal changes, and disruptions in the natural vaginal flora. BV is not considered a sexually transmitted infection (STI), but it is more common in women who are sexually active.

Clinical Presentation:

Many women with BV may not exhibit any symptoms. However, when symptoms are present, they typically include:
Thin, white, or gray vaginal discharge that has a characteristic unpleasant odor, often described as fishy.
Vaginal itching or irritation may also be present, although these symptoms are less common.
Diagnosis:
The diagnosis of BV is usually based on clinical criteria, such as the Amsel criteria mentioned earlier, which include the presence of specific clinical findings. These criteria assess vaginal discharge appearance, pH levels, the presence of clue cells on microscopy, and the positive "whiff test." Meeting three or more of these criteria is suggestive of BV.

Additional diagnostic methods that may be used include:

Microscopic examination of a vaginal swab to identify the presence of clue cells and the absence of lactobacilli.
Laboratory cultures, although these are not routinely performed in clinical practice.
Complications and Risks:
Although BV is generally not associated with serious complications, it can increase the risk of certain health issues, including:

Increased susceptibility to sexually transmitted infections, such as HIV, herpes simplex virus, chlamydia, and gonorrhea.
Pelvic inflammatory disease (PID): BV has been linked to an increased risk of developing PID, an infection of the reproductive organs that can lead to complications like chronic pelvic pain, infertility, and ectopic pregnancy.
Preterm birth: Pregnant women with BV have a higher risk of preterm birth and other pregnancy-related complications.
Management:
The primary goal of BV treatment is to relieve symptoms and restore a healthy vaginal microbiota balance. Treatment options typically include:

Antibiotic therapy: The most common approach is a course of oral or vaginal antibiotics, such as metronidazole or clindamycin, to eliminate the overgrowth of bacteria. These medications may be prescribed for a specific duration and can be given orally or as a vaginal cream or gel.
Probiotics: Some evidence suggests that using vaginal suppositories or oral probiotics containing lactobacilli may help restore the normal vaginal flora and prevent recurrence.

Amsel Criteria (2002): [ Ссылка ]

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