Aerobic vaginitis

Last updated
Aerobic vaginitis
Aerobic vaginitis phase contrast microscopy.jpg
Aerobic vaginitis: parabasal cells, absent lactobacilli and overgrowth of other bacilli, inflammation
Specialty Gynecology

Aerobic vaginitis (AV) is a form of vaginitis first described by Donders et al. in 2002. [1] [2] It is characterized by a more or less severe disruption of the lactobacillary flora, along with inflammation, atrophy, and the presence of a predominantly aerobic microflora, composed of enteric commensals or pathogens. [3]

Contents

It is the aerobic counterpart of bacterial vaginosis. The lack of acknowledgement of the difference between the two conditions might have led to inaccurate conclusions in several studies in the past. [4] The entity that has been described as "desquamative inflammatory vaginitis" probably corresponds to the more severe forms of aerobic vaginitis. [5]

Signs and symptoms

Women with aerobic vaginitis usually have a thinned reddish vaginal mucosa, sometimes with extensive erosions or ulcerations and abundant yellowish discharge (without the fishy amine odour, typical of bacterial vaginosis). The pH is usually high. Symptoms can include burning, stinging and dyspareunia. The symptoms can last for long periods—sometimes even years. Typically, patients have been treated several times with antimycotic and antibiotic drugs without relief. [3] In asymptomatic cases, there is microscopic evidence but no symptoms. The prevalence of asymptomatic cases is unknown. [3]

Complications

Aerobic vaginitis has been associated with several gynecological and obstetrical complications, including:

Diagnosis

A typical case of aerobic vaginitis; absence of lactobacilli, presence of para basal epithelial cells, and pus cells. Gram-positive cocci and Gram-negative bacilli are also present. (Gram stain) Aerobic vaginitis Gram stain.jpg
A typical case of aerobic vaginitis; absence of lactobacilli, presence of para basal epithelial cells, and pus cells. Gram-positive cocci and Gram-negative bacilli are also present. (Gram stain)

The diagnosis is based on microscopic criteria. Ideally, phase-contrast microscopy is used with a magnification of 400x (high-power field) or by Gram stain. [9] For scoring purposes, along with relative number of leucocytes, percentage of toxic leucocytes, background flora and proportion of epitheliocytes, lactobacillary grade must be evaluated:

grade I
numerous pleiomorphic lactobacilli; no other bacteria
grade IIa
mixed flora, but predominantly lactobacilli
grade IIb
mixed flora, but proportion of lactobacilli severely decreased because of an increased number of other bacteria
grade III
lactobacilli severely depressed or absent because of overgrowth of other bacteria
AV scoreLactobacillary gradesNumber of leukocytesProportion of toxic leucocytesBackground floraProportion of parabasal epitheliocytes
0I and IIa<10/hpf None or sporadicUnremarkable or cytolysis None or <1%
1IIb>10/hpf and; <10/epithelial cell <50% of leukocytesSmall coliform bacilli ≤10%
2III>10/epithelial cell>50% of leukocytesCocci or chains>10%

The "AV score" is calculated according to what is described in the table.

pH measurement alone is not enough for the diagnosis.

Treatment

Treatment is not always easy and aims at correcting the three key changes encountered in aerobic vaginitis: the presence of atrophy, inflammation and abnormal flora. The treatment can include topical steroids to diminish the inflammation and topical estrogen to reduce the atrophy. The use and choice of antibiotics to diminish the load/proportion of aerobic bacteria is still a matter of debate. The use of local antibiotics, preferably local non-absorbed and broad spectrum, covering enteric gram-positive and gram-negative aerobes, like kanamycin can be an option. In some cases, systemic antibiotics can be helpful, such as amoxyclav or moxifloxacin. [10] Vaginal rinsing with povidone iodine can provide rapid relief of symptoms but does not provide long-term reduction of bacterial loads. [11] Dequalinium chloride can also be an option for treatment. [12]

Epidemiology

About 5 to 10% of women are affected by aerobic vaginitis. [13] Reports in pregnant women point to a prevalence of 8.3–10.8%. [14] [15]

When considering symptomatic women, the prevalence of AV can be as high as 23%. [16] [17] [18]

Related Research Articles

<span class="mw-page-title-main">Bacterial vaginosis</span> Excessive growth of bacteria in the vagina

Bacterial vaginosis (BV) is a disease of the vagina caused by excessive growth of bacteria. Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon. Occasionally, there may be no symptoms. Having BV approximately doubles the risk of infection by a number of sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women.

<span class="mw-page-title-main">Candidiasis</span> Fungal infection due to any type of Candida

Candidiasis is a fungal infection due to any type of Candida. When it affects the mouth, in some countries it is commonly called thrush. Signs and symptoms include white patches on the tongue or other areas of the mouth and throat. Other symptoms may include soreness and problems swallowing. When it affects the vagina, it may be referred to as a yeast infection or thrush. Signs and symptoms include genital itching, burning, and sometimes a white "cottage cheese-like" discharge from the vagina. Yeast infections of the penis are less common and typically present with an itchy rash. Very rarely, yeast infections may become invasive, spreading to other parts of the body. This may result in fevers along with other symptoms depending on the parts involved.

<i>Gardnerella vaginalis</i> Species of bacterium

Gardnerella vaginalis is a species of Gram-variable-staining facultative anaerobic bacteria. The organisms are small non-spore-forming, nonmotile coccobacilli.

Vaginitis, also known as vulvovaginitis, is inflammation of the vagina and vulva. Symptoms may include itching, burning, pain, discharge, and a bad smell. Certain types of vaginitis may result in complications during pregnancy.

<span class="mw-page-title-main">Vaginal discharge</span> Medical condition

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Normal vaginal discharge may be large in volume but typically does not have a strong odor, nor is it typically associated with itching or pain. While most discharge is considered physiologic or represents normal functioning of the body, some changes in discharge can reflect infection or other pathological processes. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The characteristics of abnormal vaginal discharge vary depending on the cause, but common features include a change in color, a foul odor, and associated symptoms such as itching, burning, pelvic pain, or pain during sexual intercourse.

<span class="mw-page-title-main">Clue cell</span>

Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria. The etymology behind the term "clue" cell derives from the original research article from Gardner and Dukes describing the characteristic cells. The name was chosen for its brevity in describing the sine qua non of bacterial vaginosis.

Fusobacterium nucleatum is a Gram negative, anaerobic oral bacterium, commensal to the human oral cavity, that plays a role in periodontal disease. This organism is commonly recovered from different monocultured microbial and mixed infections in humans and animals. In health and disease, it is a key component of periodontal plaque due to its abundance and its ability to coaggregate with other bacteria species in the oral cavity.

<span class="mw-page-title-main">Vaginal flora</span> Microorganisms present in the vagina

Vaginal flora, vaginal microbiota or vaginal microbiome are the microorganisms that colonize the vagina. They were discovered by the German gynecologist Albert Döderlein in 1892 and are part of the overall human flora. The amount and type of bacteria present have significant implications for an individual's overall health. The primary colonizing bacteria of a healthy individual are of the genus Lactobacillus, such as L. crispatus, and the lactic acid they produce is thought to protect against infection by pathogenic species.

A vaginal disease is a pathological condition that affects part or all of the vagina.

<span class="mw-page-title-main">Vaginal yeast infection</span> Medical condition

Vaginal yeast infection, also known as candidal vulvovaginitis and vaginal thrush, is excessive growth of yeast in the vagina that results in irritation. The most common symptom is vaginal itching, which may be severe. Other symptoms include burning with urination, a thick, white vaginal discharge that typically does not smell bad, pain during sex, and redness around the vagina. Symptoms often worsen just before a woman's period.

Ureaplasma parvum is a species of Ureaplasma, a genus of bacteria belonging to the family Mycoplasmataceae. In Indonesia, ureaplasma parvum is most commonly contracted through contact with public toilets.

<span class="mw-page-title-main">Vaginal wet mount</span> Gynecologic test

A vaginal wet mount is a gynecologic test wherein a sample of vaginal discharge is observed by wet mount microscopy by placing the specimen on a glass slide and mixing with a salt solution. It is used to find the cause of vaginitis and vulvitis.

A pre-existing disease in pregnancy is a disease that is not directly caused by the pregnancy, in contrast to various complications of pregnancy, but which may become worse or be a potential risk to the pregnancy. A major component of this risk can result from necessary use of drugs in pregnancy to manage the disease.

Postcoital bleeding is bleeding from the vagina after sexual intercourse and may or may not be associated with pain. The bleeding can be from the uterus, cervix, vagina and other tissue or organs located near the vagina. Postcoital bleeding can be one of the first indications of cervical cancer. There are other reasons why vaginal bleeding may occur after intercourse. Some people will bleed after intercourse for the first time but others will not. The hymen may bleed if it is stretched since it is thin tissue. Other activities may have an effect on the vagina such as sports and tampon use. Postcoital bleeding may stop without treatment. In some instances, postcoital bleeding may resemble menstrual irregularities. Postcoital bleeding may occur throughout pregnancy. The presence of cervical polyps may result in postcoital bleeding during pregnancy because the tissue of the polyps is more easily damaged. Postcoital bleeding can be due to trauma after consensual and non-consensual sexual intercourse.

Lactobacillus crispatus is a common, rod-shaped species of genus Lactobacillus and is a hydrogen peroxide (H2O2) producing beneficial microbiota species located in both the vagina, through vaginal discharge, and the vertebrate gastrointestinal tract. The strain CTV-05 is used as a probiotic that can be used by premenopausal and postmenopausal women that experience recurrent urinary tract infections. It is being evaluated specifically for the prevention and treatment of bacterial vaginosis, which is characterized by the absence of Lactobacillus flora necessary to protect the host from infection.

The vaginal flora in pregnancy, or vaginal microbiota in pregnancy, is different from the vaginal flora before sexual maturity, during reproductive years, and after menopause. A description of the vaginal flora of pregnant women who are immunocompromised is not covered in this article. The composition of the vaginal flora significantly differs in pregnancy. Bacteria or viruses that are infectious most often have no symptoms.

<span class="mw-page-title-main">Vaginal epithelium</span>

The vaginal epithelium is the inner lining of the vagina consisting of multiple layers of (squamous) cells. The basal membrane provides the support for the first layer of the epithelium-the basal layer. The intermediate layers lie upon the basal layer, and the superficial layer is the outermost layer of the epithelium. Anatomists have described the epithelium as consisting of as many as 40 distinct layers. The mucus found on the epithelium is secreted by the cervix and uterus. The rugae of the epithelium create an involuted surface and result in a large surface area that covers 360 cm2. This large surface area allows the trans-epithelial absorption of some medications via the vaginal route.

<span class="mw-page-title-main">Lactobacillus vaccine</span> Vaccine using an inactivated strain of Lactobacillus

Lactobacillus vaccines are used in the therapy and prophylaxis of non-specific bacterial vaginitis and trichomoniasis. The vaccines consist of specific inactivated strains of Lactobacilli, called "aberrant" strains in the relevant literature dating from the 1980s. These strains were isolated from the vaginal secretions of patients with acute colpitis. The lactobacilli in question are polymorphic, often shortened or coccoid in shape and do not produce an acidic, anti-pathogenic vaginal environment. A colonization with aberrant lactobacilli has been associated with an increased susceptibility to vaginal infections and a high rate of relapse following antimicrobial treatment. Intramuscular administration of inactivated aberrant lactobacilli provokes a humoral immune response. The production of specific antibodies both in serum and in the vaginal secretion has been demonstrated. As a result of the immune stimulation, the abnormal lactobacilli are inhibited, the population of normal, rod-shaped lactobacilli can grow and exert its defense functions against pathogenic microorganisms.

References

  1. ↑ Donders, Gilbert G.G.; Vereecken, Annie; Bosmans, Eugene; Dekeersmaecker, Alfons; Salembier, Geert; Spitz, Bernard (2002). "Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis". BJOG. 109 (1): 34–43. doi: 10.1111/j.1471-0528.2002.00432.x . hdl:10067/1033820151162165141. PMID   11845812. S2CID   8304009.
  2. ↑ Donders, Gilbert G. G.; Bellen, Gert; Grinceviciene, Svitrigaile; Ruban, Kateryna; Vieira-Baptista, Pedro (2017-05-11). "Aerobic vaginitis: no longer a stranger". Research in Microbiology. 168 (9–10): 845–858. doi:10.1016/j.resmic.2017.04.004. ISSN   1769-7123. PMID   28502874.
  3. 1 2 3 Donders, G; Bellen, G; Rezeberga, D (2011). "Aerobic vaginitis in pregnancy". BJOG. 118 (10): 1163–70. doi: 10.1111/j.1471-0528.2011.03020.x . PMID   21668769. S2CID   7789770.
  4. ↑ Han, Cha; Wu, Wenjuan; Fan, Aiping; Wang, Yingmei; Zhang, Huiying; Chu, Zanjun; Wang, Chen; Xue, Fengxia (2015). "Diagnostic and therapeutic advancements for aerobic vaginitis". Archives of Gynecology and Obstetrics. 291 (2): 251–7. doi:10.1007/s00404-014-3525-9. PMID   25367602. S2CID   9753771.
  5. ↑ Newbern, EC; Foxman, B; Leaman, D; Sobel, JD (2002). "Desquamative Inflammatory Vaginitis An Exploratory Case-Control Study". Annals of Epidemiology. 12 (5): 346–52. doi:10.1016/S1047-2797(01)00316-7. PMID   12062923.
  6. ↑ Donders, G. G. G.; Moerman, P.; De Wet, G. H.; Hooft, P.; Goubau, P. (1991). "The association between Chlamydia cervicitis, chorioamnionitis and neonatal complications". Archives of Gynecology and Obstetrics. 249 (2): 79–85. doi:10.1007/BF02390366. PMID   1953055. S2CID   32669309.
  7. ↑ Donders, Gilbert; De Wet, Henry; Hooft, Peter; Desmyter, Jan (1993). "Lactobacilli in Papanicolaou Smears, Genital Infections, and Pregnancy". American Journal of Perinatology. 10 (5): 358–61. doi:10.1055/s-2007-994761. PMID   8240593.
  8. ↑ Vieira-Baptista, P.; Lima-Silva, J.; Pinto, C.; Saldanha, C.; Beires, J.; Martinez-de-Oliveira, J.; Donders, G. (2016). "Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities". European Journal of Clinical Microbiology & Infectious Diseases. 35 (4): 657–64. doi:10.1007/s10096-016-2584-1. hdl: 10067/1332670151162165141 . PMID   26810061. S2CID   17963709.
  9. ↑ Donders, G.G.G.; Larsson, P.G.; Platz-Christensen, J.J.; Hallén, A.; van der Meijden, W.; Wölner-Hanssen, P. (2009). "Variability in diagnosis of clue cells, lactobacillary grading and white blood cells in vaginal wet smears with conventional bright light and phase contrast microscopy". European Journal of Obstetrics & Gynecology and Reproductive Biology. 145 (1): 109–12. doi:10.1016/j.ejogrb.2009.04.012. PMID   19481329.
  10. ↑ Wang, C.; Han, C.; Geng, N.; Fan, A.; Wang, Y.; Yue, Y.; Zhang, H.; Xue, F. (2016). "Efficacy of oral moxifloxacin for aerobic vaginitis". European Journal of Clinical Microbiology & Infectious Diseases. 35 (1): 95–101. doi:10.1007/s10096-015-2513-8. PMID   26526787. S2CID   15238909.
  11. ↑ Donders, Gilbert G. G.; Ruban, Katerina; Bellen, Gert (2015). "Selecting Anti-Microbial Treatment of Aerobic Vaginitis". Current Infectious Disease Reports. 17 (5): 477. doi:10.1007/s11908-015-0477-6. PMID   25896749. S2CID   34979527.
  12. ↑ Mendling, Werner; Weissenbacher, Ernst Rainer; Gerber, Stefan; Prasauskas, Valdas; Grob, Philipp (2016). "Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review". Archives of Gynecology and Obstetrics. 293 (3): 469–84. doi:10.1007/s00404-015-3914-8. PMC   4757629 . PMID   26506926.
  13. ↑ Tansarli, G. S.; Kostaras, E. K.; Athanasiou, S.; Falagas, M. E. (2013). "Prevalence and treatment of aerobic vaginitis among non-pregnant women: evaluation of the evidence for an underestimated clinical entity". European Journal of Clinical Microbiology & Infectious Diseases. 32 (8): 977–84. doi:10.1007/s10096-013-1846-4. PMID   23443475. S2CID   14514975.
  14. ↑ Donders, GG; Van Calsteren, K; Bellen, G; Reybrouck, R; Van den Bosch, T; Riphagen, I; Van Lierde, S (2009). "Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy". BJOG. 116 (10): 1315–24. doi: 10.1111/j.1471-0528.2009.02237.x . PMID   19538417. S2CID   31922934.
  15. ↑ Zodzika, Jana; Rezeberga, Dace; Jermakova, Irina; Vasina, Olga; Vedmedovska, Natalija; Donders, Gilbert (2011). "Factors related to elevated vaginal pH in the first trimester of pregnancy". Acta Obstetricia et Gynecologica Scandinavica. 90 (1): 41–6. doi:10.1111/j.1600-0412.2010.01011.x. PMID   21275914. S2CID   10508510.
  16. ↑ Fan, Aiping; Yue, Yingli; Geng, Nv; Zhang, Huiying; Wang, Yingmei; Xue, Fengxia (2013). "Aerobic vaginitis and mixed infections: comparison of clinical and laboratory findings". Archives of Gynecology and Obstetrics. 287 (2): 329–35. doi:10.1007/s00404-012-2571-4. PMID   23015152. S2CID   30442929.
  17. ↑ Bologno, Romina; Díaz, Yanina M.; Giraudo, María C.; Fernández, Rosa; Menéndez, Viviana; Brizuela, Juan C.; Gallardo, Adriana A.; Álvarez, Laura A.; Estevao Belchior, Silvia G. (2011). "Importancia del estudio del balance del contenido vaginal (BACOVA) en el control preventivo de las trabajadoras sexuales" [Importance of studying the balance of vaginal content (BAVACO) in the preventive control of sex workers]. Revista Argentina de Microbiología (in Spanish). 43 (4): 246–50. doi:10.1590/S0325-75412011000400002 (inactive 31 December 2022). PMID   22274820.{{cite journal}}: CS1 maint: DOI inactive as of December 2022 (link)
  18. ↑ Marconi, C.; Donders, G.G.G.; Bellen, G.; Brown, D.R.; Parada, C.M.G.L.; Silva, M.G. (2013). "Sialidase activity in aerobic vaginitis is equal to levels during bacterial vaginosis". European Journal of Obstetrics & Gynecology and Reproductive Biology. 167 (2): 205–9. doi:10.1016/j.ejogrb.2012.12.003. hdl: 11449/74921 . PMID   23375395.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.