It is the aerobic counterpart ofbacterial vaginosis. The lack of acknowledgement of the difference between the two conditions might have led to inaccurate conclusions in several studies in the past.[4] The entity that has been described as "desquamative inflammatory vaginitis" probably corresponds to the more severe forms of aerobic vaginitis.[5]
Women with aerobic vaginitis usually have a thinned reddishvaginal mucosa, sometimes with extensive erosions or ulcerations and abundant yellowish discharge (without the fishyamine odour, typical of bacterial vaginosis). The pH is usually high. Symptoms can include burning, stinging anddyspareunia. The symptoms can last for long periods—sometimes even years. Typically, patients have been treated several times withantimycotic andantibiotic drugs without relief.[3] Inasymptomatic cases, there is microscopic evidence but no symptoms. The prevalence of asymptomatic cases is unknown.[3]
A typical case of aerobic vaginitis; absence of lactobacilli, presence of para basal epithelial cells, and pus cells. Gram-positive cocci and Gram-negative bacilli are also present. (Gram stain)
The diagnosis is based on microscopic criteria. Ideally,phase-contrast microscopy is used with a magnification of 400x (high-power field) or byGram stain.[9] For scoring purposes, along with relative number of leucocytes, percentage of toxic leucocytes, background flora and proportion of epitheliocytes, lactobacillary grade must be evaluated:
grade I
numerouspleiomorphic lactobacilli; no other bacteria
grade IIa
mixed flora, but predominantly lactobacilli
grade IIb
mixed flora, but proportion of lactobacilli severely decreased because of an increased number of other bacteria
grade III
lactobacilli severely depressed or absent because of overgrowth of other bacteria
Treatment is not always easy and aims at correcting the three key changes encountered in aerobic vaginitis: the presence of atrophy, inflammation and abnormal flora. The treatment can includetopical steroids to diminish the inflammation and topical estrogen to reduce the atrophy. The use and choice of antibiotics to diminish the load/proportion of aerobic bacteria is still a matter of debate. The use of local antibiotics, preferably local non-absorbed and broad spectrum, covering entericgram-positive andgram-negative aerobes, likekanamycin can be an option. In some cases, systemic antibiotics can be helpful, such asAmoxicillin/clavulanic acidormoxifloxacin.[10] Vaginal rinsing with povidone iodine can provide rapid relief of symptoms but does not provide long-term reduction of bacterial loads.[11]Dequalinium chloride can also be an option for treatment.[12]
^Han, Cha; Wu, Wenjuan; Fan, Aiping; Wang, Yingmei; Zhang, Huiying; Chu, Zanjun; Wang, Chen; Xue, Fengxia (2015). "Diagnostic and therapeutic advancements for aerobic vaginitis".Archives of Gynecology and Obstetrics.291 (2):251–7.doi:10.1007/s00404-014-3525-9.PMID25367602.S2CID9753771.
^Newbern, EC; Foxman, B; Leaman, D; Sobel, JD (2002). "Desquamative Inflammatory Vaginitis An Exploratory Case-Control Study".Annals of Epidemiology.12 (5):346–52.doi:10.1016/S1047-2797(01)00316-7.PMID12062923.
^Donders, G. G. G.; Moerman, P.; De Wet, G. H.; Hooft, P.; Goubau, P. (1991). "The association between Chlamydia cervicitis, chorioamnionitis and neonatal complications".Archives of Gynecology and Obstetrics.249 (2):79–85.doi:10.1007/BF02390366.PMID1953055.S2CID32669309.
^Donders, Gilbert; De Wet, Henry; Hooft, Peter; Desmyter, Jan (1993). "Lactobacilli in Papanicolaou Smears, Genital Infections, and Pregnancy".American Journal of Perinatology.10 (5):358–61.doi:10.1055/s-2007-994761.PMID8240593.S2CID32828473.
^Vieira-Baptista, P.; Lima-Silva, J.; Pinto, C.; Saldanha, C.; Beires, J.; Martinez-de-Oliveira, J.; Donders, G. (2016). "Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major Pap smear abnormalities".European Journal of Clinical Microbiology & Infectious Diseases.35 (4):657–64.doi:10.1007/s10096-016-2584-1.hdl:10067/1332670151162165141.PMID26810061.S2CID17963709.
^Donders, G.G.G.; Larsson, P.G.; Platz-Christensen, J.J.; Hallén, A.; van der Meijden, W.; Wölner-Hanssen, P. (2009). "Variability in diagnosis of clue cells, lactobacillary grading and white blood cells in vaginal wet smears with conventional bright light and phase contrast microscopy".European Journal of Obstetrics & Gynecology and Reproductive Biology.145 (1):109–12.doi:10.1016/j.ejogrb.2009.04.012.PMID19481329.
^Wang, C.; Han, C.; Geng, N.; Fan, A.; Wang, Y.; Yue, Y.; Zhang, H.; Xue, F. (2016). "Efficacy of oral moxifloxacin for aerobic vaginitis".European Journal of Clinical Microbiology & Infectious Diseases.35 (1):95–101.doi:10.1007/s10096-015-2513-8.PMID26526787.S2CID15238909.
^Donders, Gilbert G. G.; Ruban, Katerina; Bellen, Gert (2015). "Selecting Anti-Microbial Treatment of Aerobic Vaginitis".Current Infectious Disease Reports.17 (5): 477.doi:10.1007/s11908-015-0477-6.PMID25896749.S2CID34979527.
^Tansarli, G. S.; Kostaras, E. K.; Athanasiou, S.; Falagas, M. E. (2013). "Prevalence and treatment of aerobic vaginitis among non-pregnant women: evaluation of the evidence for an underestimated clinical entity".European Journal of Clinical Microbiology & Infectious Diseases.32 (8):977–84.doi:10.1007/s10096-013-1846-4.PMID23443475.S2CID14514975.
