Cytolytic Vaginosis

An overgrowth of normally protective Lactobacillus that causes vaginal discomfort

Never heard of cytolytic vaginosis? You’re not alone. Here’s what you need to know

What is Cytolytic Vaginosis?

Sometimes, it really isn’t “just another yeast infection”. Cytolytic vaginosis (CV), also known as Lactobacillus overgrowth syndrome or Doderlein's cytolysis, is a cause of vaginal discomfort caused by the overgrowth of lactobacilli. 

The result? Yeast infection-like symptoms that don’t respond to traditional anti-fungal treatments. In fact, without an accurate diagnosis, the wrong treatment can even make symptoms worse [5,6].

But there’s good news, too. While certainly uncomfortable and disruptive, CV is not a sexually transmitted disease, nor is it an infection. There are actually some simple and effective treatment options available [4].

How common is it?

Since CV is often confused with other conditions, we don’t have enough information about how many people have it.

What causes CV and what are the risk factors? 

CV is caused by an overgrowth of one of the good bacteria called Lactobacillus. It produces lactic acid which maintains an acid pH and physically pushes out competitors [1,2]. You definitely want this one around, since it offers serious protection from pathogens like Trichomonas and E. coli, effectively warding unwanted visitors like yeast infections and certain STIs [2,3].

However, sometimes there can be too much of a good thing. When lactobacilli get out of control and overgrow, these bacteria start to irritate the cells in the vaginal wall. Those dead or damaged cells then make their way out of the body alongside other normal vaginal secretions [4]. 

No one is sure about exactly what causes an overgrowth of Lactobacillus, but certain conditions and lifestyle factors can increase your risk [5]. These include:

  • Antibiotic use or use of antifungal treatments: Both are major disruptors of the delicate balance of vaginal microflora 
  • Diabetes mellitus: Lactobacillus uses glucose as energy, so having excessive amounts of glycogen provides a steady food source for the bacteria 
  • High estrogen: Symptoms might worsen when you have more estrogen in your system, such as around the ovulation period of your menstrual cycle [6]

What are the symptoms of CV?

As mentioned earlier, you might experience symptoms that mimic a yeast infection, a.k.a thrush. These include [5]:

  • Itching, irritation or burning (vulvodynia), in particular when urinating (dysuria) 
  • Discomfort during intercourse (dyspareunia)
  • White or yellowish vaginal discharge. Consistency may vary from thin to curd-like. It is usually less thick than discharge from yeast infections
  • Worsening of symptoms in the second half of the menstrual cycle  
  • Soreness 

How is CV diagnosed?

CV is difficult to diagnose and is based primarily around self-reported symptoms and a process of ruling out other conditions that have similar symptoms such as bacterial vaginosis and yeast infections (thrush). This involves testing for common pathogens such as Trichomonas, Chlamydia or Candida [5,7]. 

Your doctor can then check to see if there is an overgrowth of lactobacilli and might also see if your vaginal pH is low.

What are the treatment options? 

With so little known about CV, there is no formal standard of care [7]. While Juno Bio is working to gather more information about conditions like CV so that this can change, there are some widely used treatment options available.

The goal with treatment is to reduce the number of lactobacilli by elevating your vaginal pH. Here are a few examples of methods using a simple baking soda solution [4]:

Douching: Douche daily for 2 weeks with a mixture of 30 to 40g of baking soda in 1 liter of water

Vaginal suppository: Fill empty gelatin capsule with baking soda. Insert into the vagina twice a week for two weeks. 

Treatment should provide some immediate relief with symptoms resolving over the course of your cycle. However, if after three weeks your symptoms have not improved, have changed, or have worsened, you should stop all treatment and seek a re-evaluation from a trusted healthcare provider [4].

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

Can CV lead to other complications?

There are no known complications from CV.

What can be done to prevent CV?

There are no known ways to prevent CV.

We think it’s ridiculous that millions of women around the world are experiencing problems due to a disrupted vaginal microbiome.
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References

1. O'Hanlon D, Moench T, Cone R. Invaginal fluid, bacteria associated with bacterial vaginosis can be suppressedwith lactic acid but not hydrogen peroxide. BMC Infectious Diseases.2011;11(1).

2. Boris S, Barbés C. Role played bylactobacilli in controlling the population of vaginal pathogens. Microbes andInfection. 2000;2(5):543-546.

3. Phukan N, Parsamand T, Brooks A,Nguyen T, Simoes-Barbosa A. The adherence ofTrichomonas vaginalisto hostectocervical cells is influenced by lactobacilli. Sexually TransmittedInfections. 2013;89(6):455-459..

4. Bhat R, Rai Y, Suresh A, Rajesh A.Cytolytic vaginosis: A review. Indian Journal of Sexually Transmitted Diseasesand AIDS. 2009;30(1):48.

5. Cerikcioglu N, Beksac M. CytolyticVaginosis: Misdiagnosed as Candidal Vaginitis. Infectious Diseases inObstetrics and Gynecology. 2004;12(1):13-16.

6. Yang S, Zhang Y, Liu Y, Wang J, ChenS, Li S. Clinical Significance and Characteristic Clinical Differences ofCytolytic Vaginosis in Recurrent Vulvovaginitis. Gynecologic and ObstetricInvestigation. 2016;82(2):137-143.

7. XuH, Zhang X, Yao W, Sun Y, Zhang Y. Characterization of the vaginal microbiomeduring cytolytic vaginosis using high-throughput sequencing. Journal ofClinical Laboratory Analysis. 2018;33(1):e22653.

Written by Aisha Ommaya, science comms officer with Juno Bio

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