Selecting Anti-Microbial Treatment of Aerobic Vaginitis

  • Gilbert G. G. DondersEmail author
  • Katerina Ruban
  • Gert Bellen
Genitourinary Infections (J Sobel, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Genitourinary Infections


Aerobic vaginitis (AV) is a vaginal infectious condition which is often confused with bacterial vaginosis (BV) or with the intermediate microflora as diagnosed by Nugent’s method to detect BV on Gram-stained specimens. However, although both conditions reflect a state of lactobacillary disruption in the vagina, leading to an increase in pH, BV and AV differ profoundly. While BV is a noninflammatory condition composed of a multiplex array of different anaerobic bacteria in high quantities, AV is rather sparely populated by one or two enteric commensal flora bacteria, like Streptococcus agalactiae, Staphylocuccus aureus, or Escherichia coli. AV is typically marked by either an increased inflammatory response or by prominent signs of epithelial atrophy or both. The latter condition, if severe, is also called desquamative inflammatory vaginitis. As AV is per exclusionem diagnosed by wet mount microscopy, it is a mistake to treat just vaginal culture results. Vaginal cultures only serve as follow-up data in clinical research projects and are at most used in clinical practice to confirm the diagnosis or exclude Candida infection. AV requires treatment based on microscopy findings and a combined local treatment with any of the following which may yield the best results: antibiotic (infectious component), steroids (inflammatory component), and/or estrogen (atrophy component). In cases with Candida present on microscopy or culture, antifungals must be tried first in order to see if other treatment is still needed. Vaginal rinsing with povidone iodine can provide rapid relief of symptoms but does not provide long-term reduction of bacterial loads. Local antibiotics most suitable are preferably non-absorbed and broad spectrum, especially those covering enteric gram-positive and gram-negative aerobes, like kanamycin. To achieve rapid and short-term improvement of severe symptoms, oral therapy with amoxyclav or moxifloxacin can be used, especially in deep dermal vulvitis and colpitis infections with group B streptococci or (methicillin resistant) Staphylococcus aureus. Since the latter colonizations are frequent, but seldom inflammatory infections, we in general discourage the use of oral antibiotics in women with AV. In cases with a severe atrophy component (more than 10 % of epithelial cells are of the parabasal type), local estrogens can be used; and in postmenopausal or breast cancer patients with a contraindication for estrogens, even a combination of probiotics with an ultra-low dose of local estriol may be considered.


Aerobic vaginitis Desquamative inflammatory vaginitis Bacterial vaginosis Wet mount Microscopy Corticosteroids Vaginal treatment Metronidazole Clindamycin Gynoflor Probiotic Local estrogen Vaginal atrophy Vaginal immunity Group B streptococ Kanamycin Pregnancy complications Vaginal inflammation Leucorrhea Dyspareunia 


Compliance with Ethics Guidelines

Conflict of Interest

Gert Bellen, Kateryna Ruban, and Gilbert Donders have no relevant disclosures to report.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Gilbert G. G. Donders
    • 1
    • 2
    • 3
    • 4
    Email author
  • Katerina Ruban
    • 1
  • Gert Bellen
    • 1
  1. 1.Femicare Clinical Research for WomenTienenBelgium
  2. 2.University Hospital AntwerpAntwerpBelgium
  3. 3.Regional Hospital H HartTienenBelgium
  4. 4.Femicare vzwTienenBelgium

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