Which finding is part of Amsel's criteria for BV?

• A. Clue cells on saline smear
• B. pH > 4.5
• C. Thin, homogeneous discharge
• D. Positive Whiff test

Answer: (A)

Amsel's criteria diagnose BV by combining several clinical and microscopic findings: a thin, grayish discharge that evenly coats the vaginal walls; a vaginal pH greater than 4.5; clue cells seen on saline microscopy; and a positive amine (whiff) test after adding potassium hydroxide. The clue cells are vaginal epithelial cells whose borders are obscured by adherent bacteria, giving a characteristic cell appearance that signals overgrowth of organisms like Gardnerella. This cytologic clue is a hallmark of BV and is one of the four criteria used to make the diagnosis. Remember, a diagnosis is made when three of the four findings are present. The other criteria—pH > 4.5, thin homogeneous discharge, and a positive whiff test—are also part of the criteria and support the diagnosis when present.