Aerobic vaginitis (AV) is an inflammatory vaginal condition caused by an overgrowth of “aerobic” bacteria. This imbalance is distinct from other common vaginal issues and requires specific understanding for proper management.
What Aerobic Vaginitis Is
Aerobic vaginitis is characterized by vaginal inflammation due to an overgrowth of aerobic bacteria, which thrive in the presence of oxygen. Examples include E. coli, Staphylococcus aureus, Group B Streptococcus, and Enterococcus faecalis. These bacteria displace beneficial lactobacilli, which normally maintain a healthy vaginal environment.
This imbalance leads to various uncomfortable symptoms. These include unusual vaginal discharge, often yellowish or greenish with a “rotten” odor, persistent vaginal itching, burning sensations, redness, and swelling. Pain during sexual intercourse (dyspareunia) and urinary discomfort, such as a burning sensation when urinating, can also occur.
Comparing Aerobic Vaginitis to Other Vaginal Infections
Differentiating aerobic vaginitis from other common vaginal infections, such as bacterial vaginosis (BV) and yeast infections, is important for accurate diagnosis and effective treatment. While both AV and BV involve shifts in the vaginal microbiome and a decline in protective lactobacilli, the types of bacteria causing them differ. BV is caused by an overgrowth of anaerobic bacteria, which do not require oxygen, such as Gardnerella and Prevotella. In contrast, AV involves an increase in aerobic bacteria.
Symptoms also present with distinctions. BV typically results in a thin, grayish, or whitish discharge with a characteristic fishy odor, often worsening after intercourse. Yeast infections, caused by an overgrowth of the Candida fungus, usually present with a thick, white, cottage cheese-like discharge and intense vaginal itching. AV discharge, however, is typically sticky, yellowish to green, and can have a putrid or rotten smell, without the classic fishy odor of BV.
Vaginal pH levels and inflammatory responses also differ. In BV, the vaginal pH is usually elevated above 4.5, but there is typically a lack of inflammation on physical examination. With AV, the pH is often high, sometimes greater than 6, and there is clear evidence of inflammation, including redness, swelling, and sometimes even erosions or ulcerations of the vaginal mucosa. Yeast infections generally do not cause a significant change in vaginal pH, which usually remains around 4.0 to 4.5.
Identifying and Treating Aerobic Vaginitis
Diagnosis of aerobic vaginitis typically involves a medical evaluation. A healthcare provider will perform a pelvic examination and collect a vaginal discharge sample for laboratory analysis. Microscopic examination of the vaginal fluid identifies specific aerobic bacteria, assesses the lactobacillary grade, and quantifies white blood cells, which indicate inflammation. A high vaginal pH, often greater than 5.0, is also a common finding.
Treatment for aerobic vaginitis usually involves antibiotics. Options include clindamycin, kanamycin, or fluoroquinolones, selected based on the specific bacteria identified. Unlike bacterial vaginosis, metronidazole is generally not effective for AV.
In cases with significant inflammation, anti-inflammatory medications like topical corticosteroids may be prescribed. For postmenopausal individuals, local estrogen therapy can also be considered to help restore the vaginal environment. Medical consultation is important for accurate diagnosis and prescription of the most appropriate treatment.
Reducing Your Risk
While not all cases are preventable, certain practices can support vaginal health and potentially reduce the risk. Maintaining good hygiene, including wiping from front to back after using the toilet, helps prevent the transfer of enteric bacteria. Avoiding harsh soaps, scented feminine hygiene products, and douching is also recommended, as these can disrupt the vaginal microbiome.
Wearing breathable underwear, preferably cotton, helps maintain a dry vaginal environment. Practicing safer sex, such as using barrier methods like condoms, can lower the risk of various vaginal infections. A balanced diet and maintaining good overall health may contribute to a robust immune system and a healthier vaginal flora. If you notice any unusual vaginal symptoms, seeking timely medical advice is advisable.