Aerobic Vaginitis

An overgrowth of aerobic bacteria that causes vaginal discomfort

Woman in legwarmers doing aerobics representing aerobic vaginitis
Two bobs of different colors

You’ve heard of bacterial vaginosis (BV), but there’s a good chance that aerobic vaginitis (AV) just conjures up images of bacteria getting a workout in. Find out why it’s important to know the difference

What is aerobic vaginitis? 

AV is another cause of vaginitis (inflammation of the vagina or vulva) [1]. It has a lot in common with BV, to the point where even physicians get confused between these two conditions because they both [2]:

  • Crop up when your lactobacilli (a friendly, protective bacteria) numbers are low or non-existent
  • Make their presence known with unpleasant smelling discharge
  • Cause your vaginal pH to increase

Even though both BV and AV have similar causes and symptoms, the treatments will be different so it’s important to get the right diagnosis. To make matters even more confusing, some women might not show any symptoms at all [3]. 

Just so you know, we’re really not happy about the lack of information here.

How common is it?

Since BV and AV tend to be mixed up, it’s hard to tell how common it is. Current estimates state that between 7% and 12% of all women have it, although the majority will be asymptomatic [2].  

What causes AV and what are the risk factors?

AV is caused by one or more invading unfriendly aerobic bacteria like E. Coli or Streptococcus, whereas BV is caused by an overgrowth of anaerobic bacteria like Gardnerella [1].

Regardless of what type of bacteria is responsible for the infection, disrupting the vaginal microbiome can make you susceptible to infections. Risk factors include:

  • Having sex with multiple partners (regardless of gender) or with a new partner
  • Douching
  • Being naturally low in lactobacillus (again, more research needs to be done in this area)
  • Having low oestrogen (from losing one or both ovaries) which cuts the production of the good bacteria’s food source: glycogen
  • Hormonal changes during menstruation which causes an increase in your vaginal pH

What are the symptoms?

Again, a lot of the symptoms will be similar to BV. You might experience [2,3]: 

  • Vaginal itching 
  • Vaginal stinging or burning sensation
  • Pain during urination and/or sex
  • Abnormal discharge

Although it’s not a very pleasant symptom, the discharge might be able to help you figure out if you have AV, BV or something else. For AV, it is usually yellow and heavier and will tend to smell “rotten”, whereas with BV it will be milky white or grey with a fishy smell. If you have a yeast infection (a.k.a. thrush), you can expect more of a thick, cottage cheese-like discharge.

How is it diagnosed?

After assessing your symptoms, your doctor can perform a vaginal pH test. Anything above 4.5 is usually considered too high and unhealthy. There are other tests that can be run such as microscopy and gram staining which will look for human clue cells (that can help tell it apart from BV), and gram-negative or gram-variable bacteria [2]. Modern DNA-based methods, such as qPCR panels and next generation sequencing (NGS), are also highly effective at identifying aerobic bacteria from vaginal samples.

Based on targeted NGS, the Juno Vaginal Microbiome test is a wellness screen (not a diagnosis) that provides a full profile of all bacteria and fungi in your vagina. This can help to differentiate between AV and BV as you can see how many anaerobic or aerobic bacteria are present.

What are my treatment options?

More research needs to be done on the best treatment options. Currently, options include antibiotics to clear the AV infection, probiotics to help repopulate the vagina with healthy lactobacilli, and local estrogen therapy [3]. Topical steroids might also be prescribed to help relieve inflammation [2].

Even after treatment, AV can come back. More research needs to be done to find out why this happens, when, and how often. 

Can AV lead to other complications?

Without proper treatment, the lack of healthy and protective lactobacilli means that you are at a higher risk of other STIs [2]. AV can also lead to Pelvic Inflammatory Disease (a serious infection of the upper genital tract including the uterus) which can lead to fertility issues and other long-term health consequences [7]. Disruption of the vaginal microbiome in pregnant women can also lead to chorioamnionitis which is an infection of the fetal membrane that can cause preterm birth [4, 5].  

Bottom line? Get checked because most of the complications can be avoided with proper treatment. 

What can I do to prevent AV?

To protect yourself against infections like AV and BV, avoid disrupting the balance of protective bacteria in the vaginal microbiome by limiting the use of douches as well as the use of scented soaps, tampons or pads. To reduce your chances of getting an STI, practice safe sex by always discussing sexual health with your partner, using barrier protection correctly (such as a condom or dental dam), and getting tested regularly. 

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1. Donders G, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B. Aerobic vaginitis: Abnormal vaginal flora entity that is distinct from bacterial vaginosis. International Congress Series. 2005;1279:118-129.

2. Donders G, Bellen G, Grinceviciene S, Ruban K, Vieira-Baptista P. Aerobic vaginitis: no longer a stranger. Research in Microbiology. 2017;168(9-10):845-858.

3. Fan A, Yue Y, Geng N, Zhang H, Wang Y, Xue F. Aerobic vaginitis and mixed infections: comparison of clinical and laboratory findings. Archives of Gynecology and Obstetrics. 2012;287(2):329-335.

4. Donders G, Van Calsteren K, Bellen G, Reybrouck R, Van den Bosch T, Riphagen I et al. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology. 2009;116(10):1315-1324.

5. Krauss-Silva L, Almada-Horta A, Alves M, Camacho K, Moreira M, Braga A. Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population. BMC Pregnancy and Childbirth. 2014;14(1).

6. Bacterial Vaginosis and Desquamative Inflammatory Vaginitis. New England Journal of Medicine. 2019;380(11):1088-1089.

7. Donati L, Di Vico A, Nucci M, Quagliozzi L, Spagnuolo T, Labianca A et al. Vaginal microbial flora and outcome of pregnancy. Archives of Gynecology and Obstetrics. 2009;281(4):589-600.

Written by Aisha Ommaya, science comms officer with Juno Bio

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