Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Resident's Page
2006:72:5;392-393
doi: 10.4103/0378-6323.27768
PMID: 17050945

Clue cell

Silonie Sachdeva
 Department of Dermatology, Venereology and Leprosy, Dayanand Medical College and Hospital, Ludhiana - 141 001, Punjab, India

Correspondence Address:
Silonie Sachdeva
1312, Urban Estate, Phase-1, Jalandhar - 144 022, Punjab
India
How to cite this article:
Sachdeva S. Clue cell. Indian J Dermatol Venereol Leprol 2006;72:392-393
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology
Diagrammatic representation of clue cells coated with coccobacillary organisms with a granular appearance and stippled border
Diagrammatic representation of clue cells coated with coccobacillary organisms with a granular appearance and stippled border
Diagrammatic representation of normal vaginal squamous epithelial cells with lactobacilli. The cell margins are distinct and lack granularity
Diagrammatic representation of normal vaginal squamous epithelial cells with lactobacilli. The cell margins are distinct and lack granularity

Clue cells are vaginal squamous epithelial cells coated with the anaerobic gram-variable coccobacilli Gardnerella vaginalis and other anaerobic bacteria causing bacterial vaginosis. Clue cells were first described by Gardner and Dukes[1] in 1955 and were so named as these cells give an important "clue" to the diagnosis of bacterial vaginosis. A clue cell can be detected on simple wet mount of vaginal secretions. To be significant for bacterial vaginosis (BV), more than 20% of the epithelial cells on the wet mount should be clue cells.

Pathogenesis

Clue cell phenomenon is attributed to the attachment of adherent strains[2] of G. vaginalis in large numbers to exfoliated epithelial cells of the vagina in presence of an elevated pH. The increase in vaginal pH occurs due to alteration in normal flora characterized by a decrease in lactobacilli and increase in bacteria such as G. vaginalis ,Mycoplasma hominis and anaerobes as Mobiluncus, Bacteroides and Peptostreptococcus species. Lactobacilli help to maintain the acidic pH of healthy vagina and inhibit the growth of anaerobic microorganisms through elaboration of hydrogen peroxide.[3] Factors causing the change in flora are poorly understood. Postulates[4] include the menstrual cycle, concomitant infections, sexual activity, contraceptive methods and antibiotic use. An increase in the local pH favors the growth of bacteria causing BV. The bacteria adhere to the surface of epithelial cells leading to formation of clue cells. Lytic cellular changes are induced by the organisms on clue cells by production of enzymes such as sialidases (neuraminidases) allowing the bacteria to invade and destroy the cells.

Morphology

The clue cells can be demonstrated by microscopic examination of vaginal wet mount preparation. From the speculum, an appropriate amount of vaginal discharge is transferred on the glass slide and a droplet of normal saline is added directly. The preparation is covered with a coverslip and examined under the light microscope at 100x (low power) and 400x (high power) magnifications. The normal vaginal squamous epithelial cells have distinct cell margins and lack granularity [Figure - 1]. Clue cells are seen as squamous epithelial cells with large number of coccobacillary organisms, densely attached in clusters to their surfaces giving them a granular appearance. The cytoplasm appears fuzzy (like shading with black pencil) and the edges of the squamous epithelial cells, which normally have a sharply defined cell border, become indistinct or stippled [Figure - 2]. Polymorpho nuclear leukocytes (PMNs) can also be demonstrated on the normal vaginal wet mount preparation. The vaginal discharge of patients with BV is notable for its lack of PMNs, typically 1 or less than 1 PMN per vaginal epithelial cell.

Clinical significance

Detection of clue cells is the most useful single procedure for the diagnosis of BV. Bacterial vaginosis accounts for 10 to 30% of the cases of infectious vaginitis[5] in women of childbearing age and presents with malodorous vaginal discharge and vulvar irritation. Presence of clue cells (more than 20%) in vaginal discharge is included in Amsel′s[6] criteria for the diagnosis of BV. Other criteria for the diagnosis of BV include: milky, homogeneous, adherent discharge; vaginal pH greater than 4.5; positive whiff test i.e., typical fishy odor on addition of one or two drops of 10% KOH to vaginal discharge and "few or no lactobacilli". The presence of three of the above five is considered diagnostic. The sensitivity and specificity of more than 20% clue cells on wet mount[7] for diagnosis of BV is 81% and 99%. Identification of clue cells can also be done on Papanicolaou smear sampled from the posterior fornix with the sensitivity[8] and specificity of 90% and 97%.

The presence of clue cells in vaginal discharge has also been used to predict postoperative infections[9] after abdominal hysterectomy. Women with positive clue cell detection in air-dried vaginal smears have been found to be at increased risk of postoperative vaginal cuff infections and wound infections.

References
1.
Gardner HL, Dukes CD. Haemophilus vaginalis vaginitis. A newly defined specific infection previously classified ''Nonspecific'' vaginitis. Am J Obstet Gynecol 1955;69:962-76.
[Google Scholar]
2.
Scott TG, Smyth CJ, Keane CT. In vitro adhesiveness and biotype of Gardnerella vaginalis strains in relation to the occurrence of clue cells in vaginal discharges. Genitourin Med 1987;63:47-53.
[Google Scholar]
3.
Eschenbach DA, Davick PR, Williams BL, Klebanoff SJ, Young-Smith K, Critchlow CM, et al . Prevalence of hydrogen peroxide-producing Lactobacillus species in normal women and women with bacterial vaginosis. J Clin Microbiol 1989;27:251-6.
[Google Scholar]
4.
Saidi SA, Mandal D, Curless E. Bacterial vaginosis in a district genitourinary medicine department: Significance of vaginal microbiology and anaerobes. Int J STD AIDS 1994:5:405-8.
[Google Scholar]
5.
Sobel JD. Vaginitis. New Engl J Med 1997;337:1896-903.
[Google Scholar]
6.
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;74:14-22.
[Google Scholar]
7.
Chandeying V, Skov S, Kemapunmanus M, Law M, Geater A, Rowe P. Evaluation of two clinical protocols for the management of women with vaginal discharge in southern Thailand. Sex Transm Infect 1998;74:194-201.
[Google Scholar]
8.
Platz-Christensen JJ, Larsson PG, Sundstrom E, Bondeson L. Detection of bacterial vaginosis in Papanicolaou smears. Am J Obstet Gynecol 1989;160:132-3.
[Google Scholar]
9.
Larsson PG, Platz-Christensen JJ, Forsum U, Pahlson C. Clue cells in predicting infections after abdominal hysterectomy. Obstet Gynecol 1991;77:450-2.
[Google Scholar]

Fulltext Views
21,979

PDF downloads
3,242
Show Sections