Clinical and laboratory findings in women with bacterial vaginosis and trichomoniasis versus controls.

We report comprehensively on the clinical and laboratory findings in 30 women with bacterial vaginosis (BV), 30 with vaginal trichomoniasis and 30 with normal secretions. Women with trichomoniasis were more often divorced (chi 2 test, p much less than 0.001), more often complained of dyspareunia (chi 2 test, p less than 0.05), frequently had discharge present in the vaginal vestibule, and showed one or more signs of vaginitis in half the cases. A 'moth-eaten' cervix was seen in only four women (13%) with trichomoniasis, but can be considered pathognomonic of the condition. While the main characteristics of vaginal secretions, i.e. amount, consistency, colour, absence or presence of gas and odour, are only poorly discriminative between BV and trichomoniasis, they can be of much help in distinguishing between 'abnormal' and--probably--normal secretions. Parabasal cells were found in the wet mount of 19 women (73%) with trichomoniasis. Epithelial cell clusters were a prominent finding in controls but were virtually absent in the other two groups. We detected curved rods in 15 women (50%) with BV, but in none of the women with trichomoniasis or normal secretions. There were only minor differences in the results of bacterial cultures in cases of BV and trichomoniasis. Bacteroides and Peptostreptococcus species were the predominant anaerobes in both groups. Gardnerella vaginalis was significantly more often isolated from women with BV than from controls (chi 2 test for trend, p less than 0.001). Gas-liquid chromatography showed the presence of succinate in only two cases of BV. Lactate was found in all controls but one. Ethylation of vaginal samples probably reduces the risk of over-emphasizing the presence of succinate and lactate. It is concluded that BV and trichomoniasis are both characterized by the overgrowth of anaerobic bacteria and that there is a considerable overlap in clinical and laboratory findings. Microscopy of the wet mount should be considered the most powerful diagnostic tool.