Unifying Concepts

Amsel’s Diagnostic Criteria for Bacterial Vaginosis

Three of four criteria must be met; establishes accurate diagnosis of bacterial vaginosis in 90 percent of affected women.

  • Homogeneous vaginal discharge (color and amount may vary)
  • Amine (fishy) odor when potassium hydroxide solution is added to vaginal secretions (commonly called the “whiff test”)
  • Presence of clue cells (greater than 20%) on microscopy*
  • Vaginal pH greater than 4.5

* Highly significant criterion.



  1. Egan ME, Lipsky MS. Diagnosis of vaginitis. Am Fam Physician. 2000 Sep 1;62(5):1095-104. [Medline]
  2. Amsel R, Totten PA, Spiegel CA, Chen KC, Eschenbach D, Holmes KK. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983 Jan;74(1):14-22. [Medline]
Created: Aug 16, 2005
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