Microbial Vaginosis and its Relation to Single or Multi-Species Biofilm in Iraqi Women: Clinical and Microbiological Study.

<b>Background and Objective:</b> Bacterial vaginosis (BV) is the primary aetiology of vaginal discharge causing significant public health consequences. The study aims to detect the frequency of bacterial vaginosis and to assess the effectiveness of the Amsel's criteria and Nugent's score system as diagnostic tests for BV. <b>Materials and Methods:</b> A total of 135 high vaginal swab samples were obtained and analyzed microbiologically to detect the presence of Amsel clinical criteria and to determine the Nugent's score using gram staining. The microbiological culture, antimicrobial susceptibility test and bacterial biofilm generation were conducted using standardized laboratory conditions. The study data were analyzed using SPSS version 16.0 and Microsoft Excel. The Chi-square test was used to ascertain any significant differences with a p-value of less than 0.05. <b>Results:</b> Out of 135 HVS, 60 (44.4 %) specimens revealed bacterial vaginosis and 30 (22.2%) represent <i>Candida albicans</i> vaginitis. In comparing Amsel's criteria with Nugent's score, the sensitivity, specificity, positive and negative predictive values were 94.7, 92.3, 90 and 96%, respectively. Also, 26 (50%) of the study isolates were produced biofilm strongly. Further, <i>Gardnerella vaginalis</i> was the study isolate that produced biofilm strongly (66.6%) followed by <i>Pseudomonas aeruginosa</i> (57.1%). <b>Conclusion:</b> The study highlights the significance of Amsel's clinical criteria and the Nugent's score system as diagnostic tests for bacterial vaginosis in outpatient settings. Additionally, there is an association between recurrent bacterial vaginosis and vulvovaginal candidiasis. Moreover, addressing vaginal disorders caused by single-species or multi-species biofilms create the researcher to be focused on studying multi-species biofilms.