Aerobic Vaginitis (AV): what is it?

Everything you need to know about aerobic vaginitis and how it is different from bacterial vaginosis.

What is aerobic vaginitis (AV)?

Aerobic vaginitis (or AV for short) is a cause of painful inflammation in the vagina. It was only recently identified in research as distinctly separate from bacterial vaginosis (BV)

Both AV and BV are characterized by similarly uncomfortable symptoms such as vaginal discharge, an increase in pH, and a corresponding decrease in beneficial bacteria (Lactobacilli). Distinguishing between the two is crucial when making a diagnosis because the treatments vary and misdiagnoses may lead to aggravating symptoms. 

How common is it? 

Due to how frequently vaginal infections are misdiagnosed, finding an exact statistic for how common these conditions are can be especially hard. For the same reason, it’s likely that disorders such as aerobic vaginitis are actually more common than research suggests. 

In recent studies, AV has been observed in around 8-11% of women who are pregnant, and between 5 to 24% of all women reporting issues related to the vagina. Some research studies highlight the number of women estimated to have AV as high as 7-12% of the general population, with many individuals thought to be asymptomatic. 

While the disruption of normal bacteria responsible for causing aerobic vaginitis can be brought on by factors such as sex with new or multiple partners, it’s important to note that AV is not classified as an STI. 

What causes aerobic vaginitis?

Gynecologists and specialists for reproductive tract infections have only just begun to understand the etiology and exact mechanisms behind the infection, emphasizing the vast need for more research on this (which is where Evvy comes in!). 

For a long time, AV was commonly mistaken to be a form of “inflammatory BV.” Although both types of infections are due to a disturbance in Lactobacilli dominance, unlike BV, AV is caused by specific pathogens that require oxygen in order to reproduce (hence the name "aerobic"). The most common pathogens implicated in AV are Staphylococcus aureus and E. coli. 

Below are a few examples of factors that may disrupt your vaginal microbiome, leading to an increased risk for AV: 

  • Douching 
  • Sex with new or multiple partners
  • Hormonal changes, especially decreased levels of estrogen 

What are the symptoms of aerobic vaginitis?

AV is associated with painful inflammation of the vaginal canal. Additionally, aerobic vaginitis causes a constant shedding of the vaginal wall cells that may result in severe irritation. Other symptoms of AV you might experience are: 

  • sticky, yellow vaginal discharge (for contrast: in cases of BV, discharge will usually appear milky white or grey)
  • redness and swelling around the opening of the vagina
  • vaginal itching
  • pain during sexual intercourse
  • a stinging and/or burning sensation
  • unpleasant “rotten” smell

How is aerobic vaginitis diagnosed?

Both AV and BV are similarly diagnosed via a microscopic analysis of vaginal discharge, usually collected using a swab. Advanced DNA based testing, such as qPCR panels or next-gen sequencing (the technology used to sequence Evvy tests), can help identify aerobic bacteria from vaginal samples more accurately and precisely. 

How is aerobic vaginitis treated?

Research suggests that the ideal diagnostic approach and treatment for both AV is yet to be established. 

While mild cases of AV are often able to be treated immediately with antibiotics (clindamycin and fluoroquinolones are recommended for these bacteria), it’s common for higher levels of vaginal inflammation to require further treatment in the form of probiotics, estrogen therapy, or even the use of topical steroids. 

Keep in mind that unlike bacterial vaginosis, symptoms of aerobic vaginitis won’t respond to medications  like metronidazole—so an ineffective course of metronidazole could be an important indicator of something else going on. 

Is aerobic vaginitis associated with any other conditions or complications?

If left untreated, aerobic vaginitis can lead to the development of pelvic inflammatory disease (PID). Adverse reproductive health outcomes associated with PID include increased risk of infertility, ectopic pregnancy, preterm delivery and low birth weight. 

Additionally, many associations formerly believed to relate exclusively to BV may actually arise from vaginal infections in general (anytime where there is a decline in Lactobacilli). As a result, AV may be associated with an increased risk of acquiring STIs, such as herpes and HPV, as well as the development of cervical cancer.

The aerobic bacteria, Streptococcus agalactiae, which is present in some cases of AV has also been linked to early on-set Group B Streptococcus (GBS) disease in newborns. Although GBS is commonly found in healthy adults and rarely causes infection, it can fatally affect women who are pregnant and/or those who possess any underlying health conditions. 

How can I prevent or lower my risk of getting aerobic vaginitis?

Like many other issues specifically affecting women’s vaginal health, there is still so much that we don’t know about aerobic vaginitis. That being said, some general good practices for maintaining an optimal vaginal microbiome include: 

  • Practice safe sex and get tested regularly
  • Avoid switching between anal and vaginal sex without a condom
  • Wear breathable cotton underwear and loosely-fitted garments
  • Avoid the use of douches and scented products
  • Monitor any changes in vaginal discharge or pH

Aerobic Vaginitis Associated Bacteria: 

  • Enterococcus 
  • Streptococcus
  • Staphylococcus aureus
  • Escherichia coli

If you are experiencing any discomfort, abnormal discharge, or vaginal pain, make sure to check your pH and/or make an appointment with your doctor. If you’re curious about which bacteria are present in your microbiome and want to track changes over time, check out our Vaginal Health Test!

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Referenced in this article:

  1. Sonthalia S, Aggarwal P, Das S, Sharma P, Sharma R, Singh S. Aerobic vaginitis – An underdiagnosed cause of vaginal discharge – Narrative review. International Journal of STD & AIDS. 2020;31(11):1018-1027. doi:10.1177/0956462420913435
  2. Kaambo E, Africa C, Chambuso R, Passmore JS. Vaginal Microbiomes Associated With Aerobic Vaginitis and Bacterial Vaginosis. Front Public Health. 2018 Mar 26;6:78. doi: 10.3389/fpubh.2018.00078. PMID: 29632854; PMCID: PMC5879096.
  3. Wang ZL, Fu LY, Xiong ZA, Qin Q, Yu TH, Wu YT, Hua YY, Zhang YH. Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes. Taiwan J Obstet Gynecol. 2016 Feb;55(1):40-4. doi: 10.1016/j.tjog.2015.06.012. PMID: 26927246.
  4. Donders GGG, Bellen G, Grinceviciene S, Ruban K, Vieira-Baptista P. Aerobic vaginitis: no longer a stranger. Res Microbiol. 2017 Nov-Dec;168(9-10):845-858. doi: 10.1016/j.resmic.2017.04.004. Epub 2017 May 11. PMID: 28502874.
  5. Fan A, Yue Y, Geng N, Zhang H, Wang Y, Xue F. Aerobic vaginitis and mixed infections: comparison of clinical and laboratory findings. Arch Gynecol Obstet. 2013 Feb;287(2):329-35. doi: 10.1007/s00404-012-2571-4. Epub 2012 Sep 27. PMID: 23015152.

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