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1. 20% of epithelial cells should be clue cells to increase the specificity of the diagnosis using amsel criteria but significantly decreases the sensitivity.

2. Clue cells: squamous epithelial cells covered primarily with gardnerella which then take on this fuzzy appearance called "clue cell" as seen on wet mount of vaginal fluid. However, gardernellas can be cultured from up to 50% of normal women 9hay 1998). Therefore its presence does not therefore indicate that a woman has BV.

3. Finding of mobiluncus on microscopic exam is highly suggestive of BV.

4. Although amsel criteria is the most commonly used method to identify BV in clinical practice, there are difficulties with the individual parameters (see next slide).