Comparison of Conventional Papanicolaou, Modified Papanicolaou and Gram-stained vaginal smears in the screening of bacterial vaginosis in women attending Thika Level 5 (County) Hospital

Abstract

Bacterial vaginosis (BV) is one of the vaginal infections affecting women of reproductive age group and is associated with many gynecologic and obstetric complications including increased acquisition of Human Immunodeficiency Virus (HIV) infection. Bacterial vaginosis is asymptomatic in up to 50% of women who remain largely undiagnosed which presents a public health concern because of the potential impact of the untreated infection in these women causing increased morbidity and mortality especially in non-pregnant women. The objective of this descriptive cross-sectional study was to compare Conventional Papanicolaou, Modified Papanicolaou (Rapid Economic Acetic acid Papanicolaou-REAP) and Gram-stained vaginal smears in screening of bacterial vaginosis in women to establish if Modified Papanicolaou (REAP) was a suitable alternative to Conventional Papanicolaou method in this regard. The study findings demonstrated that Gram stain method Nugent’s scoring system which was the diagnostic gold standard in this study detected 42 positive cases of bacterial vaginosis out of 150 participants, representing a prevalence of 28% with Conventional Papanicolaou and Modified Papanicolaou (REAP) methods demonstrating 25 (16.7%) and 16 (10.7%) positive cases respectively. Using 95% confidence interval and statistically significant p value of ≤ 0.05, the study further showed that Conventional Papanicolaou and Modified Papanicolaou (REAP) methods had sensitivity of 47.6% and 26.2%, positive predictive value (PPV) of 80.0% and 68.8%, negative predictive value (NPV) of 82.4% and 76.9%, likelihood ratio of positive result (LR+) of 10.3 and 5.69, likelihood ratio of negative result (LR-) of 0.55 and 0.77 respectively with a similar specificity of 95.4% and overall diagnostic accuracy of 38.9%. In addition, the study findings demonstrated a statistically significant kappa value of 0.692 (p≤0.05) that showed moderate agreement in the diagnostic efficiency capabilities of Conventional Papanicolaou and Modified Papanicolaou (REAP) methods. In conclusion, the study showed that Modified Papanicolaou (REAP) method is a suitable alternative to Conventional Papanicolaou method in screening of bacterial vaginosis in vaginal smears. This study recommends addition of Modified Papanicolaou (REAP) method in screening of bacterial vaginosis in asymptomatic cases where the gold standard is not available.