Aerobic vaginitis: causes, symptoms, diagnosis, and treatment

Aerobic vaginitis (AV) is a vaginal inflammation caused by the decrease or absence of lactobacilli and the increase of aerobes in the vagina.


Causes

The pathogens include aerobes and facultative aerobes, such as group B streptococcus, Escherichia coli, Staphylococcus aureus, Enterococcus faecalis, Streptococcus anginosus, and Klebsiella pneumoniae.


Signs and Symptoms

10% - 20% of patients are asymptomatic. The manifestations are mainly yellow vaginal discharge, odorous discharge, burning sensation or sharp pain of the vulva, and dyspareunia. In the physical examinations, redness, swelling, ulcers, or atrophy of vaginal mucosa can be seen. The symptoms may persist for a long time, and there may be intermittent aggravation. There are relapses after treatment.


Diagnosis

There is a rating for lactobacillary grade (LBG), count of white blood cells, infected white blood cells, colonies on the background, and parabasal epitheliocytes (PBC), respectively. Each item is with a rating of 0 - 2, and the total rating is 10.

Table 1 AV rating in high power field microscopy, x400

If there are signs or symptoms, and the cumulative rating ≥ 3, the disease can be diagnosed.


Treatment

Topical treatment

The treatment regimen is 2% clindamycin ointment 5g vaginally once a day for 7 - 21 days, or kanamycin suppository 100mg vaginally once a day for 6 days.

For severe aerobic vaginitis such as desquamative vaginitis, the regimen is 2% clindamycin 5g vaginally once a day until the symptoms are relieved, followed by once or twice weekly for 2 - 6 months.

Vaginal mucosal atrophy can be treated with chlorquinaldol-promestriene tablet vaginally once daily for 12 days.

Local inflammatory reaction of vaginal mucosa can be treated with hydrocortisone 300 - 500mg vaginally once daily for 7 - 21 days, followed by hydrocortisone 300 - 500mg vaginally once or twice weekly for 2 - 6 months; or clobetasol propionate vaginally once a day for 1 week.

Systemic treatment

The treatment regimen is cefuroxime axetil 250mg orally twice a day for 7 days, levofloxacin 200mg orally twice a day for 7 days, or moxifloxacin 400mg orally once a day for 6 days.

The regimen for pregnant patients are cefuroxime 250mg orally twice a day for 7 days.