Aerobic vaginitis: no longer a stranger.

Area of Science:

• Gynecology
• Microbiology
• Infectious Diseases

Background:

• Aerobic vaginitis (AV) is a distinct vaginal infectious entity characterized by dysbiotic microflora, inflammation, and epithelial changes.
• AV shares some features with bacterial vaginosis (BV) like reduced lactobacilli but differs significantly in inflammation, discharge characteristics, and microscopic findings.
• Historically, the distinction between AV and BV has been overlooked, leading to diagnostic and management challenges.

Purpose of the Study:

• To elucidate the characteristics, diagnosis, and management of Aerobic Vaginitis (AV).
• To differentiate AV from Bacterial Vaginosis (BV) and highlight diagnostic and therapeutic implications.
• To emphasize the importance of recognizing AV as a cause of symptomatic vaginitis.

Main Methods:

• Diagnosis of AV is primarily based on wet mount microscopy with phase contrast.
• An AV score is calculated using parameters like lactobacillary grade, inflammation, leukocytes, microflora, and epithelial cells.
• Development of nucleic-acid-based and enzymatic tests is underway, but microscopy remains crucial.

Main Results:

• AV affects 7-12% of women and is less prevalent than BV.
• AV presents with vaginal redness, edema, erosions, yellow-green mucoid discharge, and potential dyspareunia.
• AV can co-occur with BV, candidiasis, STIs, and is associated with adverse pregnancy outcomes like preterm birth.

Conclusions:

• Accurate distinction between AV and BV is essential for appropriate patient management.
• Microscopic evaluation remains the gold standard for AV diagnosis.
• Treatment for AV should be individualized, potentially involving estrogens, corticosteroids, antimicrobials, and probiotics.