Aerobic vaginitis (AV) is an inflammatory vaginal microbial condition. Aerobic means the bacteria that dominate the vaginal flora prefer to live in an environment with oxygen, while vaginitis means vaginal inflammation.
The name ‘aerobic’ is a bit misleading, since many AV-related bacteria can survive in anaerobic (oxygen-free) conditions, known as facultative anaerobes.
AV can cause symptoms and comes with complications such as preterm labour, increased risk of contracting sexually transmitted infections, and abnormal Pap test results.
AV may be confused with bacterial vaginosis (BV) without proper testing.
Symptoms of aerobic vaginitis
- Inflammation of the vagina and/or vulva
- Redness
- Itching
- Soreness
- Possibly ulcers or erosions
- Changed vaginal odour
- Rotten, foul odour, faeces, rotten meat, dead smell
- Burning
- Stinging
- Swelling
- Painful sex (dyspareunia)
- Yellowish/greenish discharge
- Thick, sticky or irritating discharge
- pH may be normal or elevated (test vaginal pH at home)
- Signs of atrophy on vaginal cells
- Possibly long-lasting symptoms after multiple unsuccessful treatments
- May be asymptomatic
Most common AV-causing bacteria
The most common causes of AV are E. coli, E. faecalis, and Group B Strep.
- Escherichia coli
- Enterococcus faecalis
- Group B Strep (GBS) Streptococcus agalactiae
- Staphylococcus aureus
- Staphylococcus epidermidis
- Klebsiella
Treatment for aerobic vaginitis
There are several conventional and non-drug treatments available to treat AV. It might be important, however, to consider the greater systemic environment if AV and UTIs are recurrent/chronic.
You can find significant information and treatment recommendations for AV in Killing BV. If symptoms are non-responsive to treatment, book with a My Vagina practitioner. We understand the drivers of AV and UTIs better than most practitioners and can help.
My Vagina’s non-drug treatments for AV
My Vagina’s natural treatments for AV are powerful herbal medicines that target AV-causing bacteria specifically. The AV Vaginal Pessary does not contain any prebiotic lactulose, since lactulose contains fructose, an energy source for many AV-causing bacteria. Group B Strep is one such exception.
If you’re unsure, check the list of Bacteria that love lactulose.
Antibiotic treatment of aerobic vaginitis
Local (vaginal) antibiotics may be prescribed, often broad-spectrum, to cover gram-positive and gram-negative aerobes (like kanamycin). Oral antibiotic treatments with amoxiclav or moxifloxacin may be used, particularly if group B strep or methicillin-resistant Staphylococcus aureus (MRSA) is present.
Oral antibiotic use is discouraged in aerobic vaginitis, with topical treatments favoured by doctors due to low absorbency and high concentrations where it matters.
Treatments should maximise the survival of lactobacilli species where possible, while effectively killing gram-negative bacteria like E. coli, S. aureus and E. faecalis. Combination treatment may be most appropriate due to antibiotic resistance, but your doctor will prescribe based on your circumstances and the latest drug recommendations.
Antibiotic vaginal gel and hydrocortisone suppositories may be effective in eradicating aerobic vaginitis. Some antibiotics are problematic and won’t work, and resistance is common in some countries. Talk to your doctor about their recommendations.
AV: Getting tested and treated
Knowing the specific bacteria in your vagina via a comprehensive vaginal microbiome test is useful for targeted treatment. Discuss a microbiome panel with your doctor about antibiotic sensitivities/resistance genes.
If treatments are consistently failing, book with one of our vulvovaginal specialist naturopathic practitioners for individualised care and practitioner-only treatments.
The relationship between AV and UTIs
AV-related bacteria are implicated in urinary tract infections (UTIs), and the bacteria can migrate back and forth between the vagina and urinary tract due to proximity, or because a systemic energy source is plentiful.
In the case of frequent/chronic UTIs, just treating the vagina is unlikely to yield long-lasting results, but symptom management as the UTI issue is resolved via other means can be achieved.
AV can point to a greater systemic microbiome problem (gut, urinary tract, pathways) that may benefit from broader investigations and non-drug treatments.
Here at My Vagina’s specialist clinic, we’ve also noticed a relationship between AV and CV.
When AV turns into DIV
The most severe form of AV is called desquamative inflammatory vaginitis (DIV), but DIV may not be associated with bacteria.
Understanding the gut microbiome in AV and chronic UTI
Treatment complexity can arise with AV and UTIs because bacteria may be commensal (normal, healthy) in other areas of the body, such as the digestive tract or mouth, but have colonised the vagina or urinary tract, causing symptoms.
There may be to be a larger body-wide imbalance occurring, so treating the vagina alone may be missing the true problem. Book with a My Vagina practitioner for support – we know what to do.
Diagnosis of aerobic vaginitis
Diagnosing aerobic vaginitis requires a positive test with the dominant strain in the vaginal microbiome being one or more of the AV-causing bacteria, alongside a loss of healthy lactobacillus species, and sometimes an elevated vaginal pH reading.
The most useful test for the bacterial profile of your vagina is a comprehensive microbiome panel, which can be ordered by your practitioner or bought online yourself and done at home.
These incredible vaginal microbiome tests offer a full picture of the types and amounts of bacteria and fungus/yeast living in your vagina, microbial load, and a pH snapshot.
Examples of an AV-indicative vaginal microbiome
Getting help for recurrent AV
Download Killing BV and understand the problem in greater detail so you can choose the next best steps.
Book with a My Vagina vulvovaginal specialist naturopath or another practitioner who deeply understands the vaginal microbiome and its relationship to the rest of the body, and can provide effective treatment.
References1–5
- 1.Donders GGG, Bellen G, Grinceviciene S, Ruban K, Vieira-Baptista P. Aerobic vaginitis: no longer a stranger. Research in Microbiology. Published online November 2017:845-858. doi:10.1016/j.resmic.2017.04.004
- 2.Casa V, Noll H, Gonser S, Grob P, Graf F, Pohlig G. Antimicrobial Activity of Dequalinium Chloride against Leading Germs of Vaginal Infections. Arzneimittelforschung. Published online December 26, 2011:699-705. doi:10.1055/s-0031-1299954
- 3.Jahic M, Mulavdic M, Nurkic J, Jahic E, Nurkic M. Clinical Characteristics of Aerobic Vaginitis and Its Association to Vaginal Candidiasis, Trichomonas Vaginitis and Bacterial Vaginosis. Med Arh. Published online 2013:428. doi:10.5455/medarh.2013.67.428-430
- 4.Donders GGG, Ruban K, Bellen G. Selecting Anti-Microbial Treatment of Aerobic Vaginitis. Curr Infect Dis Rep. Published online April 22, 2015. doi:10.1007/s11908-015-0477-6
- 5.Mendling W, Weissenbacher ER, Gerber S, Prasauskas V, Grob P. Use of locally delivered dequalinium chloride in the treatment of vaginal infections: a review. Arch Gynecol Obstet. Published online October 27, 2015:469-484. doi:10.1007/s00404-015-3914-8
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