Aerobic Vaginitis - Causes, Symptoms, Diagnosis, Prevention, and Treatment

Introduction:

The vagina is a muscular canal that establishes communication between the uterus and the external environment. It plays an essential role in reproduction by providing a passage for menstruation and childbirth. The vagina is lined by a mucous membrane that gives lubrication and also contains nerve endings. It is surprising to know that the vagina harbors microbes that determine its health. The vagina is dominated by a bacteria called lactobacillus that inhibits the growth of other disease-causing microbes. But if this interaction is disturbed, other bacteria can grow and cause inflammation of the vagina.

What Is Aerobic Vaginitis?

Vaginal symbiosis ensures a healthy mutual relationship between the vaginal flora. If this relationship is disrupted, a certain type of bacteria might thrive and dominate over the other species. The disruption of lactobacillus colonies can lead to the abnormal growth of aerobic bacteria (bacteria that grow in the presence of oxygen) and enteric bacteria (bacteria that exist in the intestines). The composition of bacteria in aerobic vaginitis originates from normal intestinal microflora. This causes vaginal inflammation and leads to a condition called aerobic vaginitis.

Who Is Susceptible to Aerobic Vaginitis?

Aerobic vaginitis can affect women of any age, both pre-and post-menopause, with a prevalence estimated between 5 percent and 13 percent in asymptomatic women and higher in those with vaginal symptoms. Its occurrence among pregnant women appears to be lower. Risk factors for infection are currently being investigated.

What Causes Aerobic Vaginitis?

The harmful bacteria can overpower the colonies of good bacteria in the vagina.

The triggering factors that lead to vaginitis are:

A. Menstruation - Several hormonal changes occur during menstruation that raises the vaginal pH. The bacterial composition changes during the flow, leading to unhealthy bacteria.

B. Unprotected Sex - Having unprotected sex can introduce undesirable microbes into the vaginal canal. The use of lubricants that contain scents and glycerine can disrupt lactobacillus flora.

C. Douching - It is a vaginal washing method that introduces a stream of water along with other ingredients into the vagina. Harsh chemicals used for douching can lead to pH alterations and subsequent vaginal inflammation.

D. Stress - Alterations in the vaginal flora during extreme stress can be attributed to hormonal changes. The cortisol hormones released during stress can be harmful to the vaginal flora.

E. Antibiotics - Medications taken for other vaginal infections have the potential to kill the good bacteria as well. This leaves the vagina more vulnerable to infections from other pathogens.

F. Menopause - As women approach menopause, the estrogen levels decrease, affecting the lactobacillus colonies. The pH level and dryness in the vagina increase, causing changes in the microbiome.

What Are the Symptoms of Aerobic Vaginitis?

Patients with aerobic vaginitis can be symptomatic or asymptomatic. Evident symptoms include the following.

A. Foul Smell From the Vagina - A foul rotten smell can be present in the vagina.

B. Vaginal Discharge - Vaginal discharge is a common finding, and it can be sticky or mucoid in consistency. The color of the discharge is yellow to green and may contain pus (purulent).

C. Discomfort - Patients may experience a burning or stinging sensation in the vagina.

D. Vaginal Itching - Due to increased vaginal pH, patients have vaginal itching.

E. Painful Intercourse - During or after sexual intercourse, some patients may experience pain inside the vagina.

F. Inflammation - The vagina can appear red, swollen with erosions and ulcers. Scattered bleeding points may be present.

Is Aerobic Vaginitis a Sexually Transmitted Infection?

No, aerobic vaginitis is not a sexually transmitted infection. It is an inflammatory type of vaginal infection caused only due to a disturbed vaginal microflora.

How Is Aerobic Vaginitis Diagnosed?

Aerobic vaginitis is diagnosed by:

A. Microscopy - The vaginal discharge is collected using a swab and analyzed for microbe composition. The extent of the disease is determined by comparing the lactobacillus flora, vaginal mucosal cells (epithelial cells), and white blood cells (leukocytes). The presence of immature epithelial cells, leukocytes, and decreased lactobacillus with disrupted microflora are indicative of aerobic vaginitis.

B. Advanced Tests - To identify the aerobic bacteria precisely, advanced tests like qPCR (quantitative polymerase chain reaction) and next-generation sequencing (a type of DNA sequencing) are performed.

What Are the Potential Complications of Aerobic Vaginitis?

Aerobic vaginitis has been linked to:

• Other types of vaginitis.

• Increased risk of infection-related complications such as premature rupture of membranes, miscarriage, preterm birth, and ascending chorioamnionitis.

• Potential activation of human papillomavirus infection and cervical cancer, possibly due to elevated pH levels and reduced lactobacilli.

• Higher susceptibility to acquiring sexually transmitted infections due to vaginal mucosa erosions.

• Pelvic inflammatory disease and infertility.

How to Prevent Aerobic Vaginitis?

Aerobic vaginitis can be prevented by maintaining vaginal health through the following measures.

1. Use lukewarm water to wash your vagina without soap and scented intimate products.

2. Avoid vaginal douching.

3. Avoid lubricants containing harmful chemicals.

4. Avoid having unprotected sexual intercourse.

5. Follow a healthy and nutritious diet.

What Is the Treatment for Aerobic Vaginitis?

A. Corticosteroids - Corticosteroids mainly reduce inflammation. If the white blood cells are more, it indicates inflammation. In such situations, a topical corticosteroid is recommended.

B. Antimicrobial Drugs - Since aerobic vaginitis is a bacterial infection, the use of antiseptic solutions, oral antibiotics, and topical antibiotics like Kanamycin or Clindamycin will eradicate the pathogens.

C. Hormonal Creams - Estrogen creams can be applied topically to treatvaginal atrophy.

D. Probiotics - Vaginal probiotics restore the normal microflora and promote its health.

What Are the Differential Diagnoses for Aerobic Vaginitis?

Aerobic vaginitis differs from other types of infectious vaginitis, especially bacterial vaginosis, which it is frequently mistaken for. Bacterial vaginosis is characterized by:

• Absence of symptoms.

• Greyish-white, watery vaginal discharge with a fishy odor.

• Absence of inflammation upon vaginal examination.

• Microscopic findings show reduced lactobacilli and the presence of granular flora.

Conclusion:

Aerobic vaginitis is an uncommon condition caused by a disturbed vaginal microbiome. Lactobacillus, a commensal of the vagina, is responsible for vaginal health. Under certain conditions, these microbes are replaced by enteric bacteria (bacteria typically present in the gut), leading to aerobic vaginitis. This condition is characterized by inflammation of the vagina, discharge, malodor, burning or stinging sensations, etc. It is treated using topical corticosteroid creams, oral and topical antibiotics, estrogen creams, and vaginal probiotics. The occurrence of this condition can be easily prevented by maintaining vaginal health