Journal List > Korean J Clin Microbiol > v.15(3) > 1038252

Kim, Kim, Lee, Lee, and Lee: Detection of Trichomonas vaginalis, Gardnerella vaginalis, and Candida Species in Affirm VPIII, Papanicolaou Smear Test and Gram Stain

Abstract

Background

Infectious vaginitis is caused primarily by three different groups of microbial pathogens (Trichomonas vaginalis, Candida spp., and Gardnerella vaginalis). The objective of this study was to compare the Affirm VPIII assay using a DNA hybridization technique with the Papanicolaou (Pap) smear test and the Gram stain in the detection and identification of these three organisms.

Methods

A total of 300 vaginal samples were collected from women that were either symptomatic for vaginitis or asymptomatic women that were being seen for routine obstetric or gynecological care. The presence of T. vaginalis, Candida spp., and G. vaginalis was evaluated by using the Affirm VIII assay (Becton Dickinson, USA), Pap smear test, and Gram stain method, respectively.

Results

With the Affirm VPIII assay, 1 (0.3%) patient tested positive for T. vaginalis, 99 (33.0%) patients were positive for G. vaginalis, and 18 (6.0%) were positive for Candida spp. The detection rates of Trichomonas infection, bacterial vaginosis and candidiasis by the Pap smear test and Gram stain method were 0.7% versus 0%, 16.3% versus 35.7%, and 1.7% versus 9.7%, respectively. The differences between the detection rates of the above three organisms between the Pap smear test and the Gram stain method were statistically significant (p<0.05).

Conclusion

The Affirm VPIII assay was more sensitive than the Pap smear test and more specific than the Gram stain method for the detection and identification of these three organisms. In addition, the results of the Affirm VPIII assay are quick to obtain and are simple and easy to interpret.

Figures and Tables

Fig. 1
An Affirm VPIII Microbial Identification Test Card for 4 patient samples showing a positive result for Trichomonas vaginalis (A), Gardnerella vaginalis (B), Candida spp. (C), and mixed infection (D). Each card includes positive (bottom) and negative (top) controls for each patient sample.
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Fig. 2
Papanicolaou smear test. (A) Individual squamous cells coated with a layer of coccobacilli along the cell membranes (so-called clue cells) (Papanicolaou stain, ×400). (B) Yeasts and pseudophyphae (Papanicolaou stain, ×400).
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Fig. 3
Gram stained vaginal smear. (A) Gram negative and variable rods on the squamous cells (clue cells) (Gram stain, ×400). (B) Dark blue, dense staining of yeasts (Gram stain, ×400).
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Table 1
The results of Affirm VPIII assay, Papanicolaou (Pap) smear test, and Gram stain for Trichomonas vaginalis, Gardnerella vaginalis, and Candida spp.
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Table 2
Comparison of Affirm VPIII assay, Papanicolaou (Pap) smear test, and Gram stain for the diagnosis of bacterial vaginosis and candidiasis
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References

1. Van Der Pol B. Diagnosing Vaginal Infections: It's Time to Join the 21st Century. Curr Infect Dis Rep. 2010. 12:225–230.
2. Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991. 165:1168–1176.
3. Angotti LB, Lambert LC, Soper DE. Vaginitis: making sense of over-the-counter treatment options. Infect Dis Obstet Gynecol. 2007. 2007:97424.
4. Gravett MG, Hummel D, Eschenbach DA, Holmes KK. Preterm labor associated with subclinical amniotic fluid infection and with bacterial vaginosis. Obstet Gynecol. 1986. 67:229–237.
5. Soper DE, Bump RC, Hurt WG. Bacterial vaginosis and trichomoniasis vaginitis are risk factors for cuff cellulitis after abdominal hysterectomy. Am J Obstet Gynecol. 1990. 163:1016–1021.
6. Granato PA. Vaginitis: clinical and laboratory aspects for diagnosis. Clin Microbiol Newsletter. 2010. 32:111–116.
7. Brown HL, Fuller DD, Jasper LT, Davis TE, Wright JD. Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and Candida species in vaginitis/vaginosis. Infect Dis Obstet Gynecol. 2004. 12:17–21.
8. Gazi H, Degerli K, Kurt O, Teker A, Uyar Y, Caglar H, et al. Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection. APMIS. 2006. 114:784–787.
9. Levi AW, Harigopal M, Hui P, Schofield K, Chhieng DC. Comparison of Affirm VPIII and Papanicolaou tests in the detection of infectious vaginitis. Am J Clin Pathol. 2011. 135:442–447.
10. Carr PL, Felsenstein D, Friedman RH. Evaluation and management of vaginitis. J Gen Intern Med. 1998. 13:335–346.
11. Schwiertz A, Taras D, Rusch K, Rusch V. Throwing the dice for the diagnosis of vaginal complaints? Ann Clin Microbiol Antimicrob. 2006. 5:4.
12. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983. 74:14–22.
13. Kingston MA, Bansal D, Carlin EM. 'Shelf life' of Trichomonas vaginalis. Int J STD AIDS. 2003. 14:28–29.
14. Tokyol C, Aktepe OC, Cevrioglu AS, Altindis M, Dilek FH. Bacterial vaginosis: comparison of Pap smear and microbiological test results. Mod Pathol. 2004. 17:857–860.
15. Sobel JD, Schmitt C, Meriwether C. A new slide latex agglutination test for the diagnosis of acute Candida vaginitis. Am J Clin Pathol. 1990. 94:323–325.
16. Briselden AM, Hillier SL. Evaluation of affirm VP Microbial Identification Test for Gardnerella vaginalis and Trichomonas vaginalis. J Clin Microbiol. 1994. 32:148–152.
17. Witt A, Petricevic L, Kaufmann U, Gregor H, Kiss H. DNA hybridization test: rapid diagnostic tool for excluding bacterial vaginosis in pregnant women with symptoms suggestive of infection. J Clin Microbiol. 2002. 40:3057–3059.
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