Clue cells, as seen on a wet-mount slide, are vaginal epithelial cells with adherent coccobacilli that make the edges appear indistinct. An alternative diagnostic criterion utilizes Gram staining of vaginal secretions. The loss of lactobacillus morphotypes and increase in Gardnerella and Bacteroides morphotypes and curved gram-variable rods, when combined with the pH, correlates well with Amsel's criteria for diagnosis of bacterial vaginosis. 18 Gram stain may not be useful in determining eradication of the infection because of its high proportion of indeterminate results. Because the predictive value of a positive culture for G. vaginalis is less than 50 percent, culture is not recommended as a diagnostic tool.
Some controversy remains over the sexual transmission of bacterial vaginosis.
While it occurs more commonly in women with more than one sexual partner, bacterial vaginosis can also occur in women who are not yet sexually active. 21 Treatment of male partners has not resulted in improved cure rates or a reduced rate of recurrence. 22 Increased rates of infection with Chlamydia trachomatis and Neisseria gonorrhoeae have been reported in women with bacterial vaginosis, but increased rates of syphilis and Trichomonas infection have not been reported. 23 Treatment of male sex partners has not resulted in improved cure rates or a reduced rate of recurrence. Treatment Treatment regimens for bacterial vaginosis are shown in Table 3 .