A Comprehensive Guide to Aerobic Vaginitis (AV)

Aerobic vaginitis (AV) is a condition that causes vaginal inflammation and discomfort. Like a lot of vaginal disorders, it’s poorly studied, but there are a few things we know for sure.

For many years, aerobic vaginitis was simply seen as bacterial vaginosis with other organisms present or a form of “inflammatory bacterial vaginosis”, rather than a separate condition. But we now know that aerobic vaginitis is distinct from bacterial vaginosis (BV). 

Both aerobic vaginitis and bacterial vaginosis can cause uncomfortable symptoms like unusual vaginal discharge or an unpleasant smell. However, distinguishing between the two is crucial to receiving appropriate care.

Research suggests 7-12% of women have aerobic vaginitis. Due to how frequently vaginal infections are misdiagnosed, it’s likely that disorders such as aerobic vaginitis are actually more common than research suggests.

What causes aerobic vaginitis?

Both aerobic vaginitis and bacterial vaginosis happen when there's a shift in the vaginal microbiome, specifically a decline in protective lactobacilli and dysbiosis of the vaginal microbiome.

The main difference between these two conditions is the type of bacteria that causes them. bacterial vaginosis is caused by anaerobic bacteria — meaning, bacteria that don’t need oxygen to survive, like Gardnerella, Prevotella, and Fannyhessae. Aerobic vaginitis is caused by aerobic bacteria, which are specific pathogens that don’t mind having oxygen around, like E.coli, Staphylococcus aureus, group B Streptococcus (GBS), and Enterococcus faecalis.

Aerobic vaginitis treatment

Unfortunately, there is no clinical consensus on the best way to treat aerobic vaginitis, because it depends on the severity of symptoms and organism present.

Mild cases of aerobic vaginitis can be treated immediately with antibiotics, such as clindamycin, kanamycin, and fluoroquinolones. Vaginal probiotics may also be recommended as part of the treatment.

Keep in mind that, unlike bacterial vaginosis, symptoms of aerobic vaginitis won’t respond to metronidazole — so an ineffective course of metronidazole could be an important indicator that something else is going on. Restoring the balance of the vaginal microflora after antibiotic treatment is crucial to prevent recurrence and maintain vaginal health.

Desquamative inflammatory vaginitis and vaginal inflammation

Desquamative inflammatory vaginitis (DIV) is a rare diagnosis often given to people with a severe form of aerobic vaginitis. Desquamative inflammatory vaginitis is also associated with the same list of aerobic organisms (E. coli, S. aureus, group B strep, and Enterococcus faecalis), but it’s characterized by severe vaginal inflammation often accompanied by pain and burning.

Like aerobic vaginitis, desquamative inflammatory vaginitis is diagnosed via a microscopic analysis of vaginal discharge. The doctors are looking for signs of vaginal inflammation rather than bacterial load.

The cause of desquamative inflammatory vaginitis is controversial, while aerobic bacteria are commonly present, DIV could also be caused by anything that results in high levels of vulvar and vaginal inflammation. That is why other causes of inflammation (like sexually transmitted infections, lichen planus, or severe vaginal atrophy) need to be ruled out first.

Treatment for desquamative inflammatory vaginitis focuses on decreasing inflammation and can include clindamycin, steroids, or estrogen. Currently, there have been no randomized controlled trials to determine which treatments are best.

Risks associated with aerobic vaginitis and abnormal vaginal flora

Aerobic vaginitis is also associated with a higher risk of other health consequences including:

• Pelvic inflammatory disease (PID)
• Sexually transmitted infections (STIs)
• Human papillomavirus (HPV) and cervical cancer
• Infertility
• Adverse pregnancy outcomes (miscarriage and preterm birth)
• Neonatal issues
• Urinary tract infections (UTIs)

Additionally, major Pap smear abnormalities can occur in the context of aerobic vaginitis, impacting pregnancy outcomes and maternal health.

Pregnant individuals are also at risk for complications if S. agalactiae (Group B Streptococcus) is one of the bacteria involved in an aerobic vaginitis infection. In non-pregnant people, Streptococcus agalactiae is a common and benign member of the vaginal microbiome. However, all pregnant women are tested for GBS between 36-37 weeks because it may cause side effects for newborns. If GBS is detected during your third-trimester test, rest assured that when treated, the risk of transmission drops to almost zero.

The vaginal microbiota plays a significant role in pregnancy outcomes. An imbalance in this microbiota can lead to adverse outcomes such as preterm delivery and stillbirth. Understanding and managing the complex composition of the vaginal microbiota is crucial for maternal and neonatal health.

How can I prevent aerobic vaginitis?

While it is important to understand the differences between aerobic vaginitis and bacterial vaginosis, the preventive measures come down to the same thing: maintaining a healthy vaginal microbiome.

Some general rules of thumb include:

• Using barrier methods such as condoms and dental dams during sex
• Wiping front to back
• Changing your period products within the recommended time frame
• Avoiding douching and feminine hygiene products, which can cause an imbalance your microbiome (vaginal dysbiosis)
• Maintaining good hygiene around sex, such as washing sex toys often. 

Most importantly, it’s good practice to keep in mind the different activities and life events that can cause a shift in the microbiome and put you at an increased risk of aerobic vaginitis. Some risk factors include:

• Sex 
• Hormonal fluctuations (e.g. birth control, pregnancy, and menopause)
• Your period
• Smoking‍
• Stress

Get aerobic vaginitis care with Evvy

Care at Evvy isn’t just treatment. Built with leading OB-GYNs, it’s the first-ever platform for vaginal healthcare that combines state-of-the-art vaginal microbiome testing, prescription treatment, and 1:1 coaching to create personalized care as unique as your vaginal microbiome. Experience vaginal healthcare with Evvy today.

FAQ

How is vaginitis treated?

Vaginitis is an umbrella term used to describe an inflammation of the vagina. It can have many different causes, which means that treatment for vaginitis depends on what's causing it. Common treatments include antifungals (in the case of a yeast infection), antibiotics (in the case of a bacterial infection), steroids (for skin conditions), and hormone treatments (for vaginitis linked to menopause).

​​What is an aerobic bacterial infection?

An aerobic bacterial infection is one caused by bacteria that grow when oxygen is present.

What's the difference between bacterial vaginosis and aerobic vaginitis?

The main difference between bacterial vaginosis and aerobic vaginitis is the bacteria that cause the infections. Bacterial vaginosis is caused by anaerobic bacteria, such as Gardnerella, which don’t need oxygen to survive. On the other hand, aerobic vaginitis is caused by aerobic bacteria, including E. coli, Staphylococcus aureus, group B Streptococcus (GBS), and Enterococcus faecalis, don’t mind being exposed to oxygen environments. Bacterial vaginosis and aerobic vaginitis also cause similar but different symptoms. While they both cause abnormal vaginal discharge, bacterial vaginosis is associated with watery, gray discharge with a fishy odor while aerobic vaginitis discharge tends to be yellow or green and can have a “rotten” smell.