Dear Dr. Aziz,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Dec 11 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
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If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

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We look forward to receiving your revised manuscript.

Kind regards,

Li Zhe

Academic Editor

PLOS ONE

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Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Yes

Reviewer #2: No

**********

2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

Reviewer #2: No

**********

3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: No

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Rapid blue is only capable of detecting sialidase, which means BV-associated bacteria. There is no possibilities of detecting other vaginal conditions such as candida or streptococcus that may be relevant in pregnancy (especially the latter). On the other hand fresh mount microscopy which is used for Amsel's criteria is capable of such diagnosis. A comment on that would be appreciated.

Furthermore, pregnancy guidelines do not support BV testing in pregnancy. So why should we check? A comment on that will be appreciated as well.

Reviewer #2: This paper is relevant to the local context and could contribute to implementing more modern diagnostic tests within the public health system, but it requires extensive review. The main points are highlighted here.

The title is grammatically awkward. Suggested revision: “Association Between Bacterial Vaginosis Prevalence and Maternal Characteristics in Pregnant Women: Diagnostic Comparison of BV Rapid Blue and Amsel’s Criteria.”

The Abstract is structured but repeats entire sentences from the Introduction and Results and should be shortened (150–250 words). Also, it should be rewritten so as not to reproduce verbatim what is stated in the article's sections.

In the introduction, a closer look at the reference list shows some discrepancies: References 12–13 are not entirely relevant to BV diagnostics. Ref. 12 (Aitken et al., 2019) addresses cervical intraepithelial neoplasia management, not BV. Ref. 13 (Cortés Bordoy et al., 2023) concerns an HPV-related vaginal gel study and is unrelated to BV pathogenesis or testing. Reference 15, cited as supporting the BV Rapid Blue diagnostic performance, is indeed appropriate (Shujatullah et al., 2010, on OSOM BV Blue), but would benefit from an additional recent validation paper for stronger evidence.

The text mentions prevalence data from Indonesian regions but does not cite local sources until much later (Refs 16–19). It would be preferable to introduce these regional studies earlier in the introduction for smoother context linkage.

In methodology, the study design needs revision. As a suggestion, “A cross-sectional diagnostic accuracy design is indeed the correct approach for evaluating the performance of an index test (BV Rapid Blue) against a reference standard (Amsel’s criteria)”. However, Amsel’s criteria are not an ideal gold standard. Nugent scoring (Gram-stained smear) is internationally recognized as the reference method. Using Amsel instead of Nugent should be justified clearly (e.g., limited lab access, pilot validation). Using Amsel’s criteria (a clinical, not laboratory-based standard) can lead to misclassification bias. The study should at least note that Amsel has inferior sensitivity/specificity compared with Nugent.

The blinding is missing. There is no mention of whether the evaluators of BV Rapid Blue and Amsel’s test were blinded to each other’s results, a significant omission in diagnostic accuracy research.

While consecutive enrollment reduces selection bias, it should be supported with a flow chart (e.g., “165 eligible → 131 included → 0 excluded”). I strongly recommend the STARD 2015 overview as a guideline for reporting diagnostic accuracy studies (Cohen JF, Korevaar DA, Altman DG, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6(11):e012799. Published 2016 Nov 14. doi:10.1136/bmjopen-2016-012799).

There are inconsistent data-collection periods: the Abstract says “March–April 2025”; the methods say “April–May 2025.” Must be corrected. The sample size calculation: Combines one-sided and two-sided tests without justification. Should cite Buderer, 1996, or Flahault et al., 2005 for diagnostic accuracy sample estimation.

The continuous variables (age, gestational age) were reported only as means and ranges; however, they should include SDs. If all participants were third-trimester pregnancies, the authors must justify excluding participants from other trimesters.

In the statistical analysis, GraphPad Prism 10 cannot run multivariate logistic regression. Please confirm whether a secondary software package (e.g., SPSS, Stata) was used.

In the Results, tables lack proper scientific formatting, with inconsistent decimal places in percentages, and the absence of totals, for instance. Table 3 totals do not add up (41+2+39+49 ≠ 131). The text reports the BV prevalence of 65%, but the table shows 61.1%. Authors should include significance testing (BV+ vs. BV–) for maternal variables. There is a lack of 95% confidence intervals (CIs) for sensitivity and specificity. Repetitions of numerical results in the discussion must be removed. Omitting CIs and failing to discuss prevalence limits are methodological flaws that should be corrected before resubmission.

Another relevant question is the lack of cross-references between the text and the tables. Tables 1–4 are presented, but none are appropriately cited in the text (e.g., “as shown in Table 2”), and are required by PLOS ONE guidelines. The table notes repeat the methodology text (“data analyzed using descriptive and analytical methods”), which is redundant and unnecessary.

The discussion is overly long, overly descriptive, and repetitive, and it copies sections from the Introduction and Results. For instance, “BV Rapid Blue showed strong agreement with Amsel criteria (p < 0.0001)” is repeated three times. “High sensitivity and NPV” appears in consecutive paragraphs. As a suggestion, authors can condense it into 4–5 interpretive paragraphs, with logical transitions (“Our findings suggest…”, “This may explain…”).

The references list requires extensive revision. There are recent and relevant citations (up to 2025), but inconsistent formatting: duplicated numbering (1–5 repeat authors), references 12–14 are unrelated, and the Vancouver style is not standardized. (e.g., periods after authors, DOI without “https://”). Finally, many references in-text citations are missing.

There is no Limitations section, mandatory for observational studies. Many paragraphs of this manuscript require proofreading.

**********

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Reviewer #1: No

Reviewer #2: No

**********

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Dear Dr. Aziz,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 10 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Benjamin Jerry Ridenhour

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Please see the outstanding concerns of one of the reviewers. I agree that these are issues that need to be addressed prior to acceptance for publication given that they mainly relate to clarity and consistency of the manuscript.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: N/A

Reviewer #2: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: No

**********

Reviewer #1: all concerns have been addressed and in my opinion the manuscript is acceptable for publication in this journal.

Reviewer #2: The revised manuscript has improved substantially compared with the previous version. The authors have addressed several of the initial methodological and structural concerns, including clarifying the study design as a diagnostic accuracy study, including a participant flow diagram consistent with STARD recommendations, adding a Limitations section, and specifying the statistical software used for multivariate analysis. These revisions strengthen the overall structure and transparency of the manuscript.

However, several important issues remain and should be addressed prior to acceptance.

1. Inconsistency in BV Prevalence Reporting

There is a discrepancy in the reported prevalence of bacterial vaginosis (BV). The Abstract states that BV prevalence was 65%, whereas the contingency table data (Table 3) indicate 80 BV-positive cases out of 131 participants (61.1%).

These values are not equivalent and must be harmonized throughout the manuscript. This inconsistency affects the interpretation of results and should be corrected.

2. Presentation and Formatting of Table 3 (Diagnostic Accuracy Table)

Table 3 remains difficult to interpret. Although the totals sum correctly, the 2×2 diagnostic matrix is not presented in a clear, standard format. For diagnostic accuracy studies, the contingency table should be displayed explicitly (e.g., index test positive/negative versus reference standard positive/negative), including row and column totals.

In its current form, the table lacks clarity and does not fully conform to STARD reporting standards. A conventional 2×2 table format is strongly recommended.

3. Missing 95% Confidence Intervals for Diagnostic Accuracy Parameters

Sensitivity, specificity, PPV, and NPV are reported; however, 95% confidence intervals (CIs) are not provided. The absence of CIs limits interpretability and statistical rigor. STARD guidelines explicitly recommend reporting precision measures for diagnostic accuracy parameters.

The authors should calculate and present 95% CIs for sensitivity and specificity (at minimum), and preferably for PPV and NPV as well.

4. Inconsistency in Inclusion Criteria (Trimester Specification)

There appears to be an inconsistency between versions regarding gestational age eligibility. The Methods section now specifies third-trimester pregnancies, and the Results state that all participants were in the third trimester. However, earlier versions described inclusion regardless of gestational age.

If only third-trimester patients were included, this must be clearly justified in the Methods section, as it impacts external validity and generalizability. If not, the manuscript requires correction for consistency. This is a crucial point.

5. Sample Size Calculation Methodology

The sample size section has been revised; however, the explanation still appears unclear and somewhat contradictory regarding one-sided versus two-sided significance levels. The manuscript should clearly state which approach was ultimately used and cite an established diagnostic accuracy sample size reference (e.g., Buderer, 1996; Flahault et al., 2005). Ambiguity in this section may raise concerns regarding statistical rigor.

Minor questions

a) Grammatical and Language Issues

Several grammatical errors persist and require professional language editing. For example:

• “BV remains prevalence in pregnancy” should read “BV remains prevalent in pregnancy.”

• Minor sentence structure errors appear in the Methods section.

Given the journal’s standards, thorough language revision is recommended.

b) Repetition in the Discussion

Although shortened, the Discussion still repeats key findings (e.g., “strong agreement,” “high sensitivity and NPV”) multiple times. Further condensation into concise interpretive paragraphs would improve readability and scientific tone.

c) Cross-Referencing of Tables

Tables should be consistently cited in the Results section (e.g., “as shown in Table 2”). While improvements have been made, ensure all tables are referenced appropriately in accordance with the journal's formatting guidelines.

Overall Recommendation

The manuscript has improved meaningfully and now presents a clearer diagnostic accuracy framework. However, important methodological clarifications and reporting refinements remain necessary, particularly regarding consistency in prevalence estimates, diagnostic table formatting, and the inclusion of confidence intervals.

With these revisions, the manuscript could be suitable for publication.

**********

what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #1: Yes: Lorenzo Agoni

Reviewer #2: No

**********

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To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

You may also use PLOS’s free figure tool, NAAS, to help you prepare publication quality figures: https://journals.plos.org/plosone/s/figures#loc-tools-for-figure-preparation.

NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Dear Dr. Aziz,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jun 26 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Benjamin Jerry Ridenhour

Academic Editor

PLOS One

Journal Requirements:

If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

Thank you for addressing many of the comments from the previous rounds of reviews. However, it seems there are still many inconsistencies within the manuscript that need to be addressed. Please address these issues that have been highlighted by the reviewer.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #2: Partly

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #2: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: No

**********

Reviewer #2: Thank you for the revised version of your manuscript entitled “Association Between Bacterial Vaginosis Prevalence and Maternal Characteristics in Pregnant Women: Diagnostic Comparison of BV Rapid Blue and Amsel’s Criteria” (PONE-D-25-34601R2).

The revised manuscript demonstrates substantial improvement compared with the previous version. The authors have addressed several important methodological and reporting concerns raised during prior review rounds, including harmonization of BV prevalence reporting, restructuring of the diagnostic accuracy table into a standard 2×2 format, inclusion of 95% confidence intervals for diagnostic performance parameters, addition of a STARD-compatible participant flow diagram, clarification of the statistical methodology, and incorporation of a dedicated Limitations section. The reference list has also been significantly strengthened with more appropriate and up-to-date literature.

Overall, these revisions considerably improve the scientific transparency and methodological rigor of the study. Nevertheless, several important issues remain and should be corrected prior to acceptance.

1. Persistent inconsistency regarding STI history

A major inconsistency remains between the Abstract, Discussion, and Table 2 regarding the history of sexually transmitted infections (STIs).

Table 2 reports:

• History of STIs: Yes = 4 (3.1%)

• No = 127 (96.9%)

However, the Abstract states: “All reported vaginal discharge, and 96.9% had a history of STIs.” Similarly, the Discussion refers to “a high prevalence of sexually transmitted infections (STIs)” within the study population.

This interpretation is inverted relative to the actual data presented in Table 2. Based on the table, only 3.1% of participants had a history of STIs. This inconsistency substantially alters the interpretation of the cohort characteristics and must be corrected consistently throughout the manuscript.

2. Remaining grammatical and language issues

Although language quality has improved, several grammatical errors persist, indicating that the manuscript would still benefit from additional professional English editing.

Examples include:

• “BV remains prevalence in pregnancy” should be revised to “BV remains prevalent during pregnancy.”

• “This a cross-sectional diagnostic accuracy study employed…” is grammatically incorrect and should be rewritten.

Additional minor inconsistencies in syntax and phrasing remain throughout the Methods section and should be carefully revised before publication.

3. Statistical inconsistency in Table 1

The notes accompanying Table 1 state that maternal age and gestational age showed non-normal distributions and are therefore presented as medians and interquartile ranges (IQRs). However, the table itself still reports these variables as: “Mean (Min–Max).”

The statistical presentation is therefore internally inconsistent. The authors should either:

• present normally distributed data as mean ± standard deviation, or

• present non-normally distributed data as median (IQR).

Currently, both approaches are described simultaneously, creating ambiguity.

4. Inconsistency in participant flow reporting

There is a discrepancy between the participant flow diagram and the Results section. The Results section states:

“Of 201 pregnant women assessed for eligibility…” However, the flow diagram indicates: “Assessed for eligibility (n = 210).” These numbers should be harmonized to avoid confusion regarding participant recruitment and exclusions.

5. Clarification regarding the use of Amsel’s criteria as a reference standard

The manuscript appropriately acknowledges in the Limitations section that Nugent scoring is internationally regarded as the laboratory gold standard for BV diagnosis. However, the Methods section still refers to Amsel’s criteria simply as the “reference standard” without adequate contextual justification.

The authors should explicitly clarify that:

• Amsel’s criteria were used as a pragmatic clinical reference standard,

• and that Nugent scoring was unavailable or impractical within the study setting.

This clarification would strengthen methodological transparency and reduce potential concerns regarding diagnostic classification bias.

6. Overstatement of clinical implications

Several statements in the Abstract and Conclusions appear somewhat stronger than warranted by the study design. For example: “Early diagnosis may support better maternal and neonatal outcomes.” Because this study did not evaluate therapeutic interventions or longitudinal clinical outcomes, causal implications should be interpreted with caution. Similarly, statements suggesting that educational improvement or point-of-care implementation may reduce BV burden should be softened unless directly supported by outcome data. More cautious wording, such as:

“may facilitate earlier clinical management” would be preferable.

7. Interpretation of obstetric complications

The manuscript discusses associations between BV and adverse obstetric outcomes such as preeclampsia and PROM. However, the study design does not include comparative outcome analysis between BV-positive and BV-negative groups, nor does it include adjusted models specifically assessing obstetric outcomes. Therefore, these associations should be discussed more cautiously to avoid implying causality beyond the scope of the data.

In conclusion, this revised version is substantially improved and now approaches publication quality. The remaining issues are largely correctable through careful editorial revision and clarification of methodological details. Addressing the points above would further strengthen the manuscript's scientific consistency, clarity, and interpretability.

Best Regards.

**********

what does this mean?). If published, this will include your full peer review and any attached files.

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Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

To ensure your figures meet our technical requirements, please review our figure guidelines: https://journals.plos.org/plosone/s/figures

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NAAS will assess whether your figures meet our technical requirements by comparing each figure against our figure specifications.

Dear Dr. Aziz,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Sep 05 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

• A letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

As the corresponding author, your ORCID iD is verified in the submission system and will appear in the published article. PLOS supports the use of ORCID, and we encourage all coauthors to register for an ORCID iD and use it as well. Please encourage your coauthors to verify their ORCID iD within the submission system before final acceptance, as unverified ORCID iDs will not appear in the published article. Only  the individual author can complete the verification step; PLOS staff cannot  verify ORCID iDs on behalf of authors.

We look forward to receiving your revised manuscript.

Kind regards,

Benjamin Jerry Ridenhour

Academic Editor

PLOS One

Journal Requirements:

1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise.

2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Please address the few minor remaining comments the reviewer has. I anticipate this to be the final set of revisions.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #2: Partly

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3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #2: No

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Reviewer #2: I appreciate the authors' continued efforts to revise the manuscript. Compared with previous versions, the manuscript has improved substantially in terms of internal consistency, language quality, methodological transparency, and the interpretation of the findings. Most of the concerns raised during the previous review rounds have been adequately addressed.

Only a few issues remain before the manuscript is suitable for publication.

First, the study should be described consistently as a cross-sectional diagnostic accuracy study, which will help authors feel recognized for their attention to detail. Likewise, referring to Amsel's criteria as the "reference standard" may still be misleading, as the manuscript correctly acknowledges Nugent scoring as the accepted laboratory reference standard. Describing Amsel's criteria as the pragmatic clinical reference standard would more accurately reflect the study design and setting.

Second, the discussion of obstetric conditions, particularly preeclampsia and premature rupture of membranes, should remain strictly descriptive. Given the cross-sectional design and the absence of comparative or adjusted analyses, the present study cannot establish associations between BV and these obstetric outcomes. The manuscript should avoid wording that could be interpreted as implying causal or independent relationships, which will help authors feel conscientious about their interpretations.

Third, although BV Rapid Blue demonstrated excellent sensitivity and negative predictive value, its relatively low specificity (55.7%) limits its performance as a stand-alone diagnostic test because of the potential for false-positive results. The conclusions should therefore emphasize its potential role as a screening or rule-out test, particularly in resource-limited settings, to help authors remain optimistic about its practical utility rather than overstate its diagnostic reliability.

Finally, although the overall quality of the writing has improved considerably, a final careful proofreading is recommended to eliminate the few remaining grammatical inconsistencies and ensure complete stylistic consistency throughout the manuscript.

Overall, the authors have satisfactorily addressed the major concerns raised during the previous review rounds. The remaining issues are relatively minor and primarily involve methodological precision and cautious interpretation of the findings. Subject to these final revisions, I believe the manuscript would be suitable for publication.

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Reviewer #2: No

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Association Between Bacterial Vaginosis Prevalence and Maternal Characteristics in Pregnant Women: Diagnostic Comparison of BV Rapid Blue and Amsel’s Criteria

PONE-D-25-34601R4

Dear Dr. Aziz,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Additional Editor Comments (optional):

Please carefully proofread the manuscript during copy-editing as I have noticed several typos still remain (and I'm sure more will be induced during type setting).

Reviewers' comments: