The relationship between AV and CV

There is a specific situation where flora switches between aerobic vaginitis (AV) and cytolytic vaginosis (CV).

The vaginal microbiome goes from being dominated by AV-associated bacteria such as Escherichia coli and Enterococcus faecalis to a very high proportion of (usually) Lactobacillus crispatus, from 98 per cent or greater.

CV is very specific, and CV and AV may switch back and forth many times after various treatments.

Understanding CV – what it is and isn’t

It’s important to note that if, for example, there was 98 per cent of L. iners, at My Vagina, we would not consider this the same sort of CV (read more about L. iners dominant flora). It is very specifically L. crispatus in this AV-CV scenario, possibly L. gasseri or L. jensensii, but they are much less common.

L. iners can cause inflammation and damage cells, but L. iners isn’t a good lactic acid producer, and the circumstances whereby AV and CV switch don’t apply to L. iners. It’s not the same cause.

Dominance of L. crispatus – do I have CV?

Vaginal dominance of L. crispatus by itself is not a diagnosis of CV and may be healthy in the absence of symptoms.

If a comprehensive vaginal microbiome test or your doctor determines using microscopy that you have a high number of lactobacilli present, and you have CV symptoms, a diagnosis may be made.

Determining CV relies on the presence of matching symptoms, and a high amount on a test result alone is not definitive. Do not self-diagnose CV! It is a very specific condition.

Matching symptoms of AV and CV

In this switching of AV and CV, the symptoms often stay the same, which can be confusing, but both conditions cause inflammation and will tend to have a pH within the normal range (3.8-4.5). You may treat the AV with antibiotics, then find it’s switched to CV, but you feel more or less the same. This is common.

Symptoms of CV

Burning
Irritation
Itching
Thick or stringy white discharge

Symptoms of AV

Burning
Irritation
Itching
Yellow-green discharge
Foul odour

Why does the microbiome switch between AV and CV?

The presentation of AV and then CV (and vice versa) is a symptom picture that gives us a lot of clues. The vaginal cells offer a safe harbour only to certain types of bacteria (L. crispatus, E. coli, E. faecalis), and that’s why they can switch back and forth in this very specific way.

While the bacteria are most likely causing your vaginal symptoms, they are not the underlying problem – they are just a symptom of a bigger systemic issue that needs addressing.

This underlying problem, not just the vaginal microbiome, must be corrected, or treatment will continue to fail. See a My Vagina practitioner, and if you haven’t already, get a comprehensive vaginal microbiome test.

References^1–4

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.
Cibley LJ, Cibley LJ. Cytolytic vaginosis. American Journal of Obstetrics and Gynecology. Published online October 1991:1245-1249. doi:10.1016/s0002-9378(12)90736-x
3.
Bhat R, Suresh A, Rajesh A, Rai Y. Cytolytic vaginosis: A review. Indian J Sex Transm Dis. Published online 2009:48. doi:10.4103/0253-7184.55490
4.
Tempera G, Furneri PM. Management of Aerobic Vaginitis. Gynecol Obstet Invest. Published online 2010:244-249. doi:10.1159/000314013