Aerobic vaginitis
| Aerobic vaginitis | |
|---|---|
Gynecology |
Aerobic vaginitis (AV) is a form of
It is the aerobic counterpart of bacterial 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]
Signs and symptoms
Women with aerobic vaginitis usually have a thinned reddish
Complications
Aerobic vaginitis has been associated with several
- Premature rupture of membranes
- Preterm labour
- Ascending chorioamnionitis.[6]
- Increased risk to acquire sexually transmitted infections (including HIV)[7]
- Abnormal Pap test results[8]
Diagnosis
The diagnosis is based on microscopic criteria. Ideally, phase-contrast microscopy is used with a magnification of 400x (high-power field) or by Gram 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
- numerous pleiomorphic 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
| AV score | Lactobacillary grades | Number of leukocytes | Proportion of toxic leucocytes | Background flora | Proportion of parabasal epitheliocytes |
|---|---|---|---|---|---|
| 0 | I and IIa | <10/hpf | None or sporadic | Unremarkable or cytolysis | None or <1% |
| 1 | IIb | >10/hpf and; <10/ epithelial cell |
<50% of leukocytes | Small coliform bacilli |
≤10% |
| 2 | III | >10/epithelial cell | >50% of leukocytes | Cocci or chains | >10% |
The "AV score" is calculated according to what is described in the table.
- AV score <3: no signs of AV
- AV score 3 or 4: light AV
- AV score 5 or 6: moderate AV
- AV score ≥7:severe AV.
pH measurement alone is not enough for the diagnosis.
Treatment
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 include
Epidemiology
About 5 to 10% of women are affected by aerobic vaginitis.[13] Reports in pregnant women point to a prevalence of 8.3–10.8%.[14][15]
When considering symptomatic women, the prevalence of AV can be as high as 23%.[16][17][18]
References
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