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No, don't eliminate the Gram stain!!! It is the best laboratory method currently available for diagnosis of BV, assuming you are interpreting the stiains using the Nugent criteria (Nugent et al. J Clin Microbiol 29:297-301, 1991).
I highly recommend you eliminate culture! Since over 65% of women have Gardnerella vaginalis as part of the endogenous vaginal flora, culture for this organism has a very low specificity for diagnosis of BV. The other BV-associated organisms would require quantitative anaerobic culture which is definitely not cost effective. In addition, Enterobacteriaceae, S. aureus and Enterococcus that may be recovered on culture are part of the endogenous vaginal flora; reporting their presence is likely to lead to unnecessary antibiotic exposure.
Improve patient care and be antibiotic stewards by eliminating routine vaginal fluid culture.
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