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 provides 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 (bacterias 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.
Is Aerobic Vaginitis Common?
Aerobic vaginitis is often misdiagnosed as bacterial vaginosis (a similar condition caused by the growth of commensals in the vagina). It is not very common compared to bacterial vaginosis. This condition is observed in eight to ten percent of pregnant women. Five to 24 % of women reporting vaginal problems are diagnosed with aerobic vaginitis.
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 the development of 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.
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, topical antibiotics like Kanamycin or Clindamycin will eradicate the pathogens.
C. Hormonal Creams - Estrogen creams can be applied topically to treat vaginal atrophy.
D. Probiotics - Vaginal probiotics restore the normal microflora and promote its health.
How Is Aerobic Vaginitis Different From Bacterial Vaginosis?
Aerobic vaginitis was thought to be inflammatory bacterial vaginosis. Aerobic vaginitis has several distinguishable features, although it can coexist with bacterial vaginosis and other sexually transmitted infections.
Things to Remember:
Pregnant women should seek help from an expert before taking any medications like antibiotics or steroids. Antifungal agents and Metronidazole, popular drugs that are used to treat other vaginal infections, are not effective against aerobic vaginitis.
Conclusion:
Aerobic vaginitis is an uncommon condition caused due to 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 (bacterias typically present in the gut), leading to aerobic vaginitis. This condition is characterized by inflammation of the vagina, discharge, malodor, burning or stinging sensation, 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.
