A 26-year-old woman presents with new vaginal discharge. She reports the onset of a thin, whitish discharge with an unpleasant odor that was most prominent during her recent menses one week ago. She is sexually active only with women and reports having two sex partners during the past 6 months. She denies fevers, chills, pain during sex, pain with urination, or vaginal itching. On pelvic examination, there is no evidence of vulvovaginal inflammation, but there is a thin, white, homogeneous, “fishy-smelling” discharge.
Which one of the following is included in the Amsel criteria for diagnosing bacterial vaginosis?

Figure 1. Clue Cells
This illustration shows a microscopic examination of a vaginal wet mount. Normal vaginal epithelial cells with overlying scattered bacteria are shown on the left, and the clue cells on the right illustrate vaginal epithelial cells covered with abundant bacteria.
Illustration by Jared Travnicek, Cognition Studio

Figure 2. Nugent Scoring System for Bacterial Vaginosis
The Nugent score is based on the proportion of bacterial morphotypes listed in this figure per high power field of a gram-stained vaginal swab sample.
Source: Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297-301.
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Question Last Updated
March 10th, 2025
March 10th, 2025
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