Bacterial Vaginosis Scored Gram Stain and Candida Smear
Test Mnemonic
BVCNSM
CPT Codes
- 87205 - QTY (1)
LOINC ®
14361-0
Aliases
- Bacterial Vaginitis
- Candidiasis
- Fungal Smear
- Gram Stain
- Vaginitis
- Vaginitis Exam
- Vaginosis
- Vaginosis Exam
- Yeast Infection
Includes
- A scored microscopic examination for normal versus abnormal vaginal flora
- Microscopic examination for fungal elements
Performing Laboratory
Cleveland Clinic Laboratories
Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| Unspecified | Vaginal | Swab | Ambient | Culturette swab in non-nutritive transport medium (eg, Amies or Stuart) |
Stability
| Environmental Condition | Description |
|---|---|
| Ambient | 1 week |
| Refrigerated | 1 week |
| Frozen | Unacceptable |
Days Performed
Sun - Sat
Turnaround Time
1 day
Methodology
| Name | Description |
|---|---|
| Gram Stain |
Reference Range
Special Info
This test is constructed for the diagnosis of bacterial vaginosis (BV) and confirmation of the presence of yeasts, primarily Candida species, in women clinically suspected to have vulvovaginal candidiasis. If it is unclear that the patient has bacterial vaginosis, candidiasis or Trichomonas, then the recommended test is the Affirm (VAGDNA). This test is a probe test intended for use in patients with clinical signs and symptoms of vaginitis. The test detects Candida species, Trichomonas vaginalis and Gardnerella vaginalis nucleic acid in vaginal fluid specimens. Clinical criteria for the diagnosis of bacterial vaginosis (BV) include 1) thin, homogeneous vaginal discharge, 2) clue cells (vaginal squamous epithelial cells coated with bacteria that mask the cell border), 3) increased vaginal pH (>4.5), and 4) fishy odor of vaginal excretions enhanced by adding KOH. Women with BV may report no signs or symptoms. BV is not fully understood, but the condition is associated with a reduction in normal Lactobacillus flora and an increase in other bacteria including Gardnerella vaginalis, Mobiluncus and Bacteroides. BV has been associated with increased susceptibility to sexually transmitted diseases (HIV, HSV, gonorrhea, chlamydia) and obstetric complications (miscarriage, preterm birth, postpartum endometritis).
Clinical Info
Determination of a score for the relative amounts of microbial morphologies observed in a Gram stain of vaginal fluid is the definitive method for diagnosing bacterial vaginosis. A predominance of medium to large gram positive bacilli is suggestive of lactobacilli (score 0-3) is consistent with normal vaginal flora. A predominance of gram negative or gram variable rods is suggestive of Gardnerella vaginalis, Mobiluncus and Bacteriodes sp (score 7-10) is consistent with bacterial vaginosis. An intermediate score (4-6) suggests a transition from normal vaginal flora. Additionally this method is used for the confirmation of vulvovaginal candidiasis. Exudative material on a swab should be submitted for microscopic examination to detect the presence of yeasts.