Microbiology

New Orderable: Gram stain for BV and Yeast

The new orderable for the Gram stain for BV and yeast is available

The Gram stain for bacterial vaginosis (BV) and yeast is considered the gold standard for the diagnosis of various vaginal infections. The Gram stain utilizes the Nugent scoring method to evaluate the ratios of Lactobacillus, Gardnerella vaginalis, Mobiluncus, and Atopobium vaginae. Accurate diagnosis of BV relies upon both the increase in abundance of specific urogenital pathogens (such as Gardnerella) as well as the concordant decrease in the amount of otherwise protective “usual flora” (Lactobacillus). In addition to scoring the abundance of these organisms, the Gram stain may also be used to quantify yeast making suspected contributions to BV.

By replacing traditional genital culture with the Nugent Gram stain, turnaround time is decreased and the reported results more reliably predict true vaginal infections as opposed to underlying colonization often detected by culture. For these reasons, solely performing a Gram stain is more appropriate for patient care.

The Nugent Gram stain should not be ordered for the specific detection of Group A (GAS) or Group B Streptococcus (GBS). For pregnant patients, a GBS PCR is the most sensitive and specific test for detecting this pathogen. If the Clinician is suspecting GAS in a cervical or vaginal specimen, culture is preferred and is available as a separate orderable.

The best method for diagnosing sexually transmitted infections caused by organisms such as Neisseria gonorrhea or Chlamydia is a PCR assay as these organisms may not grow under routine culture conditions or be reliably detected by Gram stain. Antigen and nucleic acid-based tests are available when infection with Trichomonas is suspected.

Below is a chart of ICD 10 codes as a helpful guide for the Clinician when deciding whether Gram stain or culture is appropriate for a given patient. These are only examples of common ICD-10 codes. This is not a comprehensive list. As always, please code to the most specific diagnosis available.

ICD 10 code and description

BV Gram stain

Wound culture

B96.89 Other specified bacterial agents as the cause of diseases classified elsewhere

X

L22.0 Diaper dermatitis

X

L29.0 Pruritus ani

X

N76.0 Acute vaginitis

X

N76.1 Subacute and chronic vaginitis

X

N94.1 Dyspareunia

X

N94.89 Other specified conditions associated with female genital organs and menstrual cycle

X

N89.8 Other specified noninflammatory disorders of vagina

X

R10.2 Pelvic and perineal pain

X

Z12.4 Encounter for screening for malignant neoplasm of cervix

X

N39.0 Urinary tract infection, site not specified

This code is for urine culture and not to be used with vaginal specimens.

All Microbiology concerns and questions may be direct to Mary Coram, Microbiology Manager, or to Dr. Adam Caulfield, Microbiology Director by using the Contact Us link above.

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