Evaluation of the Application of Wright-Giemsa Staining in the Comprehensive Diagnosis of Vaginitis

DOI: 10.12201/bmr.202510.00052

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  Abstract: Objective　To systematically evaluate the application potential and diagnostic efficacy of Wright-Giemsa staining in the comprehensive diagnosis of vaginitis. Methods　A total of 1,222 consecutive outpatients in the gynecology department were enrolled. All patients underwent speculum examination and vaginal secretion sample collection. The samples were subjected to wet-mount microscopy, Wright-Giemsa stained smear microscopy, Gram-stained smear microscopy, and functional index detection (including pH value, leukocyte esterase, and sialidase). Wilcoxon signed-rank test, McNemar test, and Kappa consistency test were used to analyze the differences and consistency of three microscopic examination methods in detecting WBC score, PBC score, AV background bacteria score, LBG, LBG score, lactobacillus abundance score, Mobiluncus score, Gardnerella score, fungi, trichomonas, and clue cells. Spearman correlation test was applied to analyze the correlation between WBC score, LBG, Gardnerella score and their corresponding functional indices. Kappa consistency test was used to analyze the inter-observer consistency of Wright-Giemsa staining. Indicators such as sensitivity, specificity, and area under the ROC curve (AUC) were calculated to evaluate the diagnostic efficacy of Wright-Giemsa staining. Results　Wilcoxon signed-rank test showed that Wright-Giemsa staining had significantly higher grade judgments than Gram staining for LBG, PBC score, AV background bacteria score, WBC score, Gardnerella score, and Mobiluncus score (all P<0.0167), while its Lactobacillus abundance score was significantly lower than that of Gram staining (P<0.0001). Compared with wet mount method, Wright-Giemsa staining had significantly lower grade judgments for WBC score, LBG, LBG score, AV background bacteria, and Lactobacillus abundance score (all P<0.0001), but significantly higher grade judgment for Gardnerella score (P<0.0001); additionally, Mobiluncus was not detected by wet mount method. Spearman correlation test indicated that Gardnerella score and LBG of Wright-Giemsa staining had the best correlation with sialidase and pH, respectively (r=0.6922, 0.7861). McNemar test showed that the detection rate of fungi by Wright-Giemsa staining was significantly higher than that by wet mount method (P<0.0001), the detection rate of trichomonas was significantly higher than that by Gram staining (P=0.002), and the detection rate of clue cells was significantly higher than that by both wet mount method and Gram staining (all P<0.0001). Inter-observer consistency analysis revealed moderate to high consistency for all indicators except clue cells (Kappa=0.390 for some observers), with Kappa values as high as 0.829~0.854 for Mobiluncus score and PBC score. The sensitivity and specificity of Wright-Giemsa staining in diagnosing VVC, TV, BV, and CV all exceeded 0.90. Conclusion　Wright-Giemsa staining boasts the advantages of high detection rate, high consistency, low cost, and easy operation in the diagnosis of vaginitis. It enables the comprehensive diagnosis of vaginitis and is expected to become a routine method for this purpose, especially holding significant promotion value in areas with limited medical resources. Furthermore, it can be combined with AI technology to achieve automatic auxiliary diagnosis of vaginitis, thereby improving diagnostic efficiency and consistency.

  Key words: Wright-Giemsa staining; Gram staining; vaginitis; comprehensive diagnosis

  Submit time: 28 October 2025

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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