Vulvar Disease pp 167-205 | Cite as

Candidiasis, Bacterial Vaginosis, Trichomoniasis and Other Vaginal Conditions Affecting the Vulva

  • Pedro Vieira-Baptista
  • Jacob Bornstein


Vulvovaginitis encompasses few conditions, which may be infectious or inflammatory. The common practice of symptomatic, empiric approach to management of vulvovaginitis is very limited. A significant number of women will not fit the “traditional” diagnosis of candidiasis, bacterial vaginosis, or trichomoniasis. These conditions are discussed, as well as desquamative inflammatory vaginitis, group B streptococcus (GBS) vaginitis, leptothrix, cytolytic vaginosis, lactobacillosis, vaginal atrophy and the newer entity of aerobic vaginitis.


  1. 1.
    Sobel JD, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol. 1998;178:203–11.PubMedGoogle Scholar
  2. 2.
    Mendling W, et al. Guideline: vulvovaginal candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis). Mycoses. 2015;58:1–15.PubMedGoogle Scholar
  3. 3.
    Nedovic B, et al. Mannose-binding lectin codon 54 gene polymorphism and vulvovaginal candidiasis: a systematic review and meta-analysis. Biomed Res Int. 2014;2014:1–7.Google Scholar
  4. 4.
    Donders GGG, Bellen G, Mendling W. Management of recurrent vulvo-vaginal candidosis as a chronic illness. Gynecol Obstet Investig. 2010;70:306–21.Google Scholar
  5. 5.
    Matsubara VH, Wang Y, Bandara HMHN, Mayer MPA, Samaranayake LP. Probiotic lactobacilli inhibit early stages of Candida albicans biofilm development by reducing their growth, cell adhesion, and filamentation. Appl Microbiol Biotechnol. 2016;100:6415–26.PubMedGoogle Scholar
  6. 6.
    Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369:1961–71.PubMedGoogle Scholar
  7. 7.
    Sobel JD, Subramanian C, Foxman B, Fairfax M, Gygax SE. Mixed vaginitis-more than coinfection and with therapeutic implications. Curr Infect Dis Rep. 2013;15:104–8.PubMedGoogle Scholar
  8. 8.
    Lindner JG, Plantema FH, Hoogkamp-Korstanje JA. Quantitative studies of the vaginal flora of healthy women and of obstetric and gynaecological patients. J Med Microbiol. 1978;11:233–41.PubMedGoogle Scholar
  9. 9.
    Beigi RH, Meyn LA, Moore DM, Krohn MA, Hillier SL. Vaginal yeast colonization in nonpregnant women: a longitudinal study. Obstet Gynecol. 2004;104:926–30.PubMedGoogle Scholar
  10. 10.
    Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Morb Mortal Wkly Rep. 2015;64:1–137.Google Scholar
  11. 11.
    Ventolini G. Progresses in vaginal microflora physiology and implications for bacterial vaginosis and candidiasis. Women’s Health (Lond Engl). 2016;12:283–91.Google Scholar
  12. 12.
    Dennerstein GJ, Ellis DH. Oestrogen, glycogen and vaginal candidiasis. Aust N Z J Obstet Gynaecol. 2001;41:326–8.PubMedGoogle Scholar
  13. 13.
    Alves CT, et al. Effect of progesterone on Candida albicans vaginal pathogenicity. Int J Med Microbiol. 2014;304:1011–7.PubMedGoogle Scholar
  14. 14.
    Donders G, et al. Influence of contraceptive choice on vaginal bacterial and fungal microflora. Eur J Clin Microbiol Infect Dis. 2017;36:43–8.PubMedGoogle Scholar
  15. 15.
    Erol O, Simavlı S, Derbent AU, Ayrım A, Kafalı H. The impact of copper-containing and levonorgestrel-releasing intrauterine contraceptives on cervicovaginal cytology and microbiological flora: a prospective study. Eur J Contracept Reprod Health Care. 2014;19:187–93.PubMedGoogle Scholar
  16. 16.
    Lete I, Cuesta MC, Marín JM, Guerra S. Vaginal health in contraceptive vaginal ring users – a review. Eur J Contracept Reprod Health Care. 2013;18:234–41.PubMedGoogle Scholar
  17. 17.
    Farage M, Bramante M, Otaka Y, Sobel J. Do panty liners promote vulvovaginal candidiasis or urinary tract infections? Eur J Obstet Gynecol Reprod Biol. 2007;132:8–19.PubMedGoogle Scholar
  18. 18.
    Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA. 2004;291:1368–79.PubMedGoogle Scholar
  19. 19.
    Holzer I, Farr A, Kiss H, Hagmann M, Petricevic L. The colonization with Candida species is more harmful in the second trimester of pregnancy. Arch Gynecol Obstet. 2017;295:891–5.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Garcia-Flores J, et al. Candida chorioamnionitis: report of two cases and review of literature. J Obstet Gynaecol. 2016;36:843–4.PubMedGoogle Scholar
  21. 21.
    Hester RA, Kennedy SB. Candida infection as a risk factor for HIV transmission. J Womens Health. 2003;12:487–94.Google Scholar
  22. 22.
    Foster DC, et al. Site-specific mesenchymal control of inflammatory pain to yeast challenge in vulvodynia-afflicted and pain-free women. Pain. 2015;156:386–96.PubMedPubMedCentralGoogle Scholar
  23. 23.
    Ferris DG, Dekle C, Litaker MS. Women’s use of over-the-counter antifungal medications for gynecologic symptoms. J Fam Pract. 1996;42:595–600.PubMedGoogle Scholar
  24. 24.
    Emmerson J, et al. Sampling for vaginal candidosis: how good is it? Int J STD AIDS. 1994;5:356–8.PubMedGoogle Scholar
  25. 25.
    Cartwright CP, et al. Comparison of nucleic acid amplification assays with BD affirm VPIII for diagnosis of vaginitis in symptomatic women. J Clin Microbiol. 2013;51(11):3694–9. Scholar
  26. 26.
    Brown HL, Fuller DD, Jasper LT, Davis TE, Wright JD. Clinical evaluation of affirm VPIII in the detection and identification of Trichomonas vaginalis, Gardnerella vaginalis, and candida species in vaginitis/vaginosis. Infect Dis Obstet Gynecol. 2004;12:17–21.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Weissenbacher T, et al. Relationship between clinical diagnosis of recurrent vulvovaginal candidiasis and detection of candida species by culture and polymerase chain reaction. Arch Gynecol Obstet. 2009;279:125–9.PubMedGoogle Scholar
  28. 28.
    Donders G, et al. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol. 2008;199:613.e1–9.Google Scholar
  29. 29.
    Donders GGG, et al. Role of molecular biology in diagnosis and characterization of Vulvo-vaginitis in clinical practice. Gynecol Obstet Investig. 2017;82:607–16.Google Scholar
  30. 30.
    Gaydos CA, et al. Clinical validation of a test for the diagnosis of vaginitis. Obstet Gynecol. 2017;130:181–9.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Martin Lopez JE. Candidiasis (vulvovaginal). BMJ Clin Evid. 2015. pii: 0815.
  32. 32.
    Pitsouni E, Iavazzo C, Falagas ME. Itraconazole vs fluconazole for the treatment of uncomplicated acute vaginal and vulvovaginal candidiasis in nonpregnant women: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol. 2008;198(2):153–60. Scholar
  33. 33.
    Consolaro MEL, Albertoni TA, Svidzinski AE, Peralta RM, Svidzinski TIE. Vulvovaginal candidiasis is associated with the production of germ tubes by Candida albicans. Mycopathologia. 2005;159:501–7.PubMedGoogle Scholar
  34. 34.
    Mahmoudabadi AZ, Najafyan M, Moghimipour E, Alwanian M, Seifi Z. Lamisil versus clotrimazole in the treatment of vulvovaginal candidiasis. Iran J Microbiol. 2013;5:86–90.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Ferahbas A, et al. Terbinafine versus Itraconazole and fluconazole in the treatment of vulvovaginal candidiasis. Am J Ther. 2006;13(4):332–6. Scholar
  36. 36.
    Sobel JD, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004;351:876–83.PubMedGoogle Scholar
  37. 37.
    Dennerstein GJ. Depo-Provera in the treatment of recurrent vulvovaginal candidiasis. J Reprod Med. 1986;31:801–3.PubMedGoogle Scholar
  38. 38.
    Vieira-Baptista P, Donders G. Is it possible to prevent recurrent vulvovaginitis? The role of lactobacillus plantarum I1001 (CECT7504). Eur J Clin Microbiol Infect Dis. 2017;36(3):593–4. Scholar
  39. 39.
    Papaemmanouil V, et al. Prevalence and susceptibility of Saccharomyces cerevisiae causing vaginitis in Greek women. Anaerobe. 2011;17:298–9.PubMedGoogle Scholar
  40. 40.
    Nyirjesy P, et al. Saccharomyces cerevisiae vaginitis: transmission from yeast used in baking. Obstet Gynecol. 1995;86:326–9.PubMedGoogle Scholar
  41. 41.
    Kissinger P. Epidemiology and treatment of trichomoniasis. Curr Infect Dis Rep. 2015;17:31.Google Scholar
  42. 42.
    Petrin D, Delgaty K, Bhatt R, Garber G. Clinical and microbiological aspects of Trichomonas vaginalis. Clin Microbiol Rev. 1998;11:300–17.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Fichorova R, Fraga J, Rappelli P, Fiori PL. Trichomonas vaginalis infection in symbiosis with Trichomonasvirus and mycoplasma. Res Microbiol. 2017;168(9–10):882–91. Scholar
  44. 44.
    Menezes CB, Amanda Piccoli Frasson AP, Tasca T. Trichomoniasis – are we giving the deserved attention to the most common non-viral sexually transmitted disease worldwide? Microb Cell. 2016;3:404–18.PubMedPubMedCentralGoogle Scholar
  45. 45.
    Rowley J, Toskin I, Ndowa F, World Health Organization. Reproductive health and research. Global incidence and prevalence of selected curable sexually transmitted infections, 2008. Geneva: World Health Organization; 2012.Google Scholar
  46. 46.
    Krieger JN. Trichomoniasis in men: old issues and new data. Sex Transm Dis. 1995;22:83–96.PubMedGoogle Scholar
  47. 47.
    Byun JM, et al. Experience of successful treatment of patients with metronidazole-resistant Trichomonas vaginalis with zinc sulfate: a case series. Taiwan J Obstet Gynecol. 2015;54:617–20.PubMedGoogle Scholar
  48. 48.
    Sena AC, et al. Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment, and prevention. Clin Infect Dis. 2007;44:13–22.PubMedGoogle Scholar
  49. 49.
    Schwebke JR, Burgess D. Trichomoniasis. Clin Microbiol Rev. 2004;17:794–803.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Donders GGG, Depuydt C. Increased prevalence of Trichomonas vaginalis in mid-aged women is linked to sexual activity and not to hormonal changes. J Low Genit Tract Dis. 2013;17:e31–2.PubMedGoogle Scholar
  51. 51.
    Sutton M, et al. The prevalence of Trichomonas vaginalis infection among reproductive-age women in the United States, 2001–2004. Clin Infect Dis. 2007;45:1319–26.PubMedGoogle Scholar
  52. 52.
    Freeman AH, et al. Prevalence and correlates of Trichomonas vaginalis among incarcerated persons assessed using a highly sensitive molecular assay. Sex Transm Dis. 2010;37:165–8.PubMedGoogle Scholar
  53. 53.
    Sherrard J, Donders G, White D. European (IUSTI/WHO) guideline on the management of vaginal discharge, 2011. Int J STD AIDS. 2011;22:421–9.PubMedGoogle Scholar
  54. 54.
    Lima-Silva J, Vieira-Baptista P, Cavaco-Gomes J, Maia T, Beires J. Emphysematous vaginitis. J Low Genit Tract Dis. 2015;19:e43–4.PubMedGoogle Scholar
  55. 55.
    Silver BJ, Guy RJ, Kaldor JM, Jamil MS, Rumbold AR. Trichomonas vaginalis as a cause of perinatal morbidity: a systematic review and meta-analysis. Sex Transm Dis. 2014;41:369–76.PubMedGoogle Scholar
  56. 56.
    Cotch MF, et al. Trichomonas vaginalis associated with low birth weight and preterm delivery. The vaginal Infections and Prematurity Study Group. Sex Transm Dis. 1997;24:353–60.PubMedGoogle Scholar
  57. 57.
    Donders G, Bellen G, Rezeberga D. Aerobic vaginitis in pregnancy. BJOG. 2011;118:1163–70.PubMedGoogle Scholar
  58. 58.
    Fastring DR, et al. Co-occurrence of Trichomonas vaginalis and bacterial Vaginosis and vaginal shedding of HIV-1 RNA. Sex Transm Dis. 2014;41:173–9.PubMedGoogle Scholar
  59. 59.
    Mavedzenge SN, et al. Epidemiological synergy of Trichomonas vaginalis and HIV in Zimbabwean and south African women. Sex Transm Dis. 2010;37:460–6.PubMedGoogle Scholar
  60. 60.
    Donders GGG, Depuydt CE, Bogers J-P, Vereecken AJ. Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low risk women. PLoS One. 2013;8:e86266.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Hamilton H, et al. Trichomonas vaginalis brain abscess in a neonate. Clin Infect Dis. 2017;66(4):604–7. Scholar
  62. 62.
    Jones HE, Lippman SA, Caiaffa-Filho HH, Young T, van de Wijgert JHHM. Performance of a rapid self-test for detection of Trichomonas vaginalis in South Africa and Brazil. J Clin Microbiol. 2013;51:1037–9.PubMedPubMedCentralGoogle Scholar
  63. 63.
    Van Der Pol B. Clinical and laboratory testing for Trichomonas vaginalis infection. J Clin Microbiol. 2016;54:7–12.Google Scholar
  64. 64.
    Wiese W, Patel SR, Patel SC, Ohl CA, Estrada CA. A meta-analysis of the Papanicolaou smear and wet mount for the diagnosis of vaginal trichomoniasis. Am J Med. 2000;108:301–8.PubMedGoogle Scholar
  65. 65.
    Nathan B, et al. Microscopy outperformed in a comparison of five methods for detecting Trichomonas vaginalis in symptomatic women. Int J STD AIDS. 2015;26:251–6.PubMedGoogle Scholar
  66. 66.
    Nye MB, Schwebke JR, Body BA. Comparison of APTIMA Trichomonas vaginalis transcription-mediated amplification to wet mount microscopy, culture, and polymerase chain reaction for diagnosis of trichomoniasis in men and women. Am J Obstet Gynecol. 2009;200:188.e1–7.Google Scholar
  67. 67.
    Gaydos CA, et al. Rapid diagnosis of Trichomonas vaginalis by testing vaginal swabs in an isothermal helicase-dependent AmpliVue assay. Sex Transm Dis. 2016;43:369–73.PubMedPubMedCentralGoogle Scholar
  68. 68.
    Perl G. Errors in the diagnosis of trichomonas vaginalis infections as observed among 1199 patients. Obstet Gynecol. 1972;39:7–9.PubMedGoogle Scholar
  69. 69.
    Badman SG, et al. A preliminary evaluation of a new GeneXpert (Gx) molecular point-of-care test for the detection of Trichomonas vaginalis. Sex Transm Infect. 2016;92:350–2.PubMedGoogle Scholar
  70. 70.
    Visapää J-P, Tillonen JS, Kaihovaara PS, Salaspuro MP. Lack of disulfiram-like reaction with metronidazole and ethanol. Ann Pharmacother. 2002;36:971–4.PubMedGoogle Scholar
  71. 71.
    Sobel R, Sobel JD. Metronidazole for the treatment of vaginal infections. Expert Opin Pharmacother. 2015;16:1109–15.PubMedGoogle Scholar
  72. 72.
    Schwebke JR, Lensing SY, Sobel J. Intravaginal metronidazole/miconazole for the treatment of vaginal trichomoniasis. Sex Transm Dis. 2013;40:710–4.PubMedGoogle Scholar
  73. 73.
    Klebanoff MA, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with asymptomatic Trichomonas vaginalis infection. N Engl J Med. 2001;345:487–93.PubMedGoogle Scholar
  74. 74.
    Gülmezoglu AM, Azhar M. Interventions for trichomoniasis in pregnancy. Cochrane Database Syst Rev. 2011;11:CD000220. Scholar
  75. 75.
    Crucitti T. Eve’s garden: myths, legends and secrets unmasked. Res Microbiol. 2017;168(9–10):773–81. Scholar
  76. 76.
    Donders G, Vieira-Baptista P. Bacterial vaginosis and inflammatory response showed association with severity of cervical neoplasia in HPV-positive women. Diagn Cytopathol. 2016;45(5):472–3.PubMedGoogle Scholar
  77. 77.
    Donders GGG, et al. Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG. 2002;109:34–43.PubMedGoogle Scholar
  78. 78.
    Vieira-Baptista P, et al. Bacterial vaginosis, aerobic vaginitis, vaginal inflammation and major pap smear abnormalities. Eur J Clin Microbiol Infect Dis. 2016;35:1–8. Scholar
  79. 79.
    Ravel J, et al. Vaginal microbiome of reproductive-age women. Proc Natl Acad Sci U S A. 2011;108(Suppl 1):4680–7. Scholar
  80. 80.
    Miller EA, Beasley DE, Dunn RR, Archie EA. Lactobacilli dominance and vaginal pH: why is the human vaginal microbiome unique? Front Microbiol. 2016;7:1936.PubMedPubMedCentralGoogle Scholar
  81. 81.
    Blackwell AL. Vaginal bacterial phaginosis? Sex Transm Infect. 1999;75:352–3.PubMedPubMedCentralGoogle Scholar
  82. 82.
    Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN. Risks for acquisition of bacterial vaginosis among women who report sex with women: a cohort study. PLoS One. 2010;5:e11139.PubMedPubMedCentralGoogle Scholar
  83. 83.
    Harada K, et al. Vaginal infection with Ureaplasma urealyticum accounts for preterm delivery via induction of inflammatory responses. Microbiol Immunol. 2008;52:297–304.PubMedGoogle Scholar
  84. 84.
    Nasioudis D, Linhares I, Ledger W, Witkin S. Bacterial vaginosis: a critical analysis of current knowledge. BJOG An Int J Obstet Gynaecol. 2017;124:61–9.Google Scholar
  85. 85.
    Hay P. Bacterial vaginosis. F1000Res. 2017;6:1761.PubMedPubMedCentralGoogle Scholar
  86. 86.
    Allsworth JE, Peipert JF. Prevalence of bacterial vaginosis. Obstet Gynecol. 2007;109:114–20.PubMedGoogle Scholar
  87. 87.
    Vieira-Baptista P, et al. Genital tract infections in an isolated community: 100 women of the Príncipe Island. Infect Dis Obstet Gynecol. 2017;2017:3058569.PubMedPubMedCentralGoogle Scholar
  88. 88.
    Yen S, et al. Bacterial vaginosis in sexually experienced and non-sexually experienced young women entering the military. Obstet Gynecol. 2003;102:927–33.PubMedGoogle Scholar
  89. 89.
    Marrazzo JM, Thomas KK, Agnew K, Ringwood K. Prevalence and risks for bacterial vaginosis in women who have sex with women. Sex Transm Dis. 2010;37:335–9.PubMedPubMedCentralGoogle Scholar
  90. 90.
    Gottschick C, et al. The urinary microbiota of men and women and its changes in women during bacterial vaginosis and antibiotic treatment. Microbiome. 2017;5:99.PubMedPubMedCentralGoogle Scholar
  91. 91.
    Gray RH, et al. The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda. Am J Obstet Gynecol. 2009;200(42):e1–7.Google Scholar
  92. 92.
    Bilardi JE, et al. Women view key sexual behaviours as the trigger for the onset and recurrence of bacterial vaginosis. PLoS One. 2017;12:e0173637.PubMedPubMedCentralGoogle Scholar
  93. 93.
    Brotman RM, et al. Association between cigarette smoking and the vaginal microbiota: a pilot study. BMC Infect Dis. 2014;14:471.PubMedPubMedCentralGoogle Scholar
  94. 94.
    Petrova MI, Reid G, Vaneechoutte M, Lebeer S. Lactobacillus iners: friend or foe? Trends Microbiol. 2017;25:182–91.PubMedGoogle Scholar
  95. 95.
    Marrazzo JM, Antonio M, Agnew K, Hillier SL. Distribution of genital lactobacillus strains shared by female sex partners. J Infect Dis. 2009;199:680–3.PubMedPubMedCentralGoogle Scholar
  96. 96.
    Taylor-Robinson D, McCaffrey M, Pitkin J, Lamont RF. Bacterial vaginosis in climacteric and menopausal women. Int J STD AIDS. 2002;13:449–52.PubMedGoogle Scholar
  97. 97.
    Eschenbach DA, Gravett MG, Chen KC, Hoyme UB, Holmes KK. Bacterial vaginosis during pregnancy. An association with prematurity and postpartum complications. Scand J Urol Nephrol Suppl. 1984;86:213–22.PubMedGoogle Scholar
  98. 98.
    Unemo M, et al. Sexually transmitted infections: challenges ahead. Lancet Infect Dis. 2017;17:e235–79.PubMedGoogle Scholar
  99. 99.
    Donders GGG, Ruban K, Bellen G, Petricevic L. Mycoplasma/Ureaplasma infection in pregnancy: to screen or not to screen. J Perinat Med. 2017;45:505–15.PubMedGoogle Scholar
  100. 100.
    Cohen CR, et al. Bacterial vaginosis associated with increased risk of female-to-male HIV-1 transmission: a prospective cohort analysis among African couples. PLoS Med. 2012;9:e1001251.PubMedPubMedCentralGoogle Scholar
  101. 101.
    Babu G, Singaravelu BG, Srikumar R, Reddy SV, Kokan A. Comparative study on the vaginal flora and incidence of asymptomatic vaginosis among healthy women and in women with infertility problems of reproductive age. J Clin Diagn Res. 2017;11:DC18–22.PubMedPubMedCentralGoogle Scholar
  102. 102.
    Amsel R, et al. Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. Am J Med. 1983;74(1):14–22. Scholar
  103. 103.
    Mittal V, Jain A, Pradeep Y, Pradeep Y. Development of modified diagnostic criteria for bacterial vaginosis at peripheral health centres in developing countries. J Infect Dev Countries. 2012;6:373–7.Google Scholar
  104. 104.
    Hay P, Tummon A, Ogunfile M, Adebiyi A, Adefowora A. Evaluation of a novel diagnostic test for bacterial vaginosis: ‘the electronic nose’. Int J STD AIDS. 2003;14:114–8.PubMedGoogle Scholar
  105. 105.
    Huppert JS, et al. Accuracy and trust of self-testing for bacterial vaginosis. J Adolesc Health. 2012;51:400–5.PubMedPubMedCentralGoogle Scholar
  106. 106.
    Geva A, Bornstein J, Dan M, Shoham HK, Sobel JD. The VI-SENSE–vaginal discharge self-test to facilitate management of vaginal symptoms. Am J Obstet Gynecol. 2006;195:1351–6.PubMedGoogle Scholar
  107. 107.
    Nugent R, Krohn M, Hillier S. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol. 1991;29:297–301.PubMedPubMedCentralGoogle Scholar
  108. 108.
    Donders GGG. Definition and classification of abnormal vaginal flora. Best Pract Res Clin Obstet Gynaecol. 2007;21:355–73.PubMedGoogle Scholar
  109. 109.
    Ison CA, Hay PE. Validation of a simplified grading of gram stained vaginal smears for use in genitourinary medicine clinics. Sex Transm Infect. 2002;78:413–5.PubMedPubMedCentralGoogle Scholar
  110. 110.
    Stockdale CK. A positive culture result for gardnerella is not diagnostic of bacterial vaginosis. J Low Genit Tract Dis. 2016;20:281–2.PubMedGoogle Scholar
  111. 111.
    Madhivanan P, et al. Performance of BVBlue rapid test in detecting bacterial vaginosis among women in Mysore, India. Infect Dis Obstet Gynecol. 2014;2014:908313.PubMedPubMedCentralGoogle Scholar
  112. 112.
    Calderón E, Rivera R. Evaluation of a fast test to identify the presence of proline aminopeptidase in women with bacterial Vaginosis. Infect Dis Obstet Gynecol. 1997;231:226–31.Google Scholar
  113. 113.
    Rumyantseva T a, Bellen G, Savochkina YA, Guschin a E, Donders GGG. Diagnosis of aerobic vaginitis by quantitative real-time PCR. Arch Gynecol Obstet. 2016;294(1):109–14. Scholar
  114. 114.
    Oduyebo OO, Anorlu RI, Ogunsola FT. In: Oduyebo OO, editor. Cochrane database of systematic reviews. Hoboken: Wiley; 2009. p. CD006055. Scholar
  115. 115.
    Donders GG, Zodzika J, Rezeberga D. Treatment of bacterial vaginosis: what we have and what we miss. Expert Opin Pharmacother. 2014;15:645–57.PubMedGoogle Scholar
  116. 116.
    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. 2015;293(3):469–84. Scholar
  117. 117.
    Schuyler JA, et al. Identification of intrinsically metronidazole-resistant clades of Gardnerella vaginalis. Diagn Microbiol Infect Dis. 2016;84:1–3.PubMedGoogle Scholar
  118. 118.
    Donders G, et al. Improvement of abnormal vaginal flora in Ugandan women by self-testing and short use of intravaginal antimicrobials. Eur J Clin Microbiol Infect Dis. 2016;36(4):731–8. Scholar
  119. 119.
    Chaithongwongwatthana S, Limpongsanurak S, Sitthi-Amorn C. Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial. J Med Assoc Thail. 2003;86(Suppl 2):S379–84.Google Scholar
  120. 120.
    Krasnopolsky VN, et al. Efficacy of vitamin C vaginal tablets as prophylaxis for recurrent bacterial vaginosis: a randomised, double-blind, placebo-controlled clinical trial. J Clin Med Res. 2013;5:309–15.PubMedPubMedCentralGoogle Scholar
  121. 121.
    Tan H, Fu Y, Yang C, Ma J. Effects of metronidazole combined probiotics over metronidazole alone for the treatment of bacterial vaginosis: a meta-analysis of randomized clinical trials. Arch Gynecol Obstet. 2017;295:1331–9.PubMedGoogle Scholar
  122. 122.
    Ugwumadu A, Manyonda I, Reid F, Hay P. Effect of early oral clindamycin on late miscarriage and preterm delivery in asymptomatic women with abnormal vaginal flora and bacterial vaginosis: a randomised controlled trial. Lancet. 2003;361:983–8.PubMedGoogle Scholar
  123. 123.
    Larsson P-G, et al. Late miscarriage and preterm birth after treatment with clindamycin: a randomised consent design study according to Zelen. BJOG. 2006;113:629–37.PubMedGoogle Scholar
  124. 124.
    Lamont RF, Jones BM, Mandal D, Hay PE, Sheehan M. The efficacy of vaginal clindamycin for the treatment of abnormal genital tract flora in pregnancy. Infect Dis Obstet Gynecol. 2003;11:181–9.PubMedPubMedCentralGoogle Scholar
  125. 125.
    Yudin MH, Money DM. No. 211-screening and management of bacterial vaginosis in pregnancy. J Obstet Gynaecol Canada. 2017;39:e184–91.Google Scholar
  126. 126.
    Bradshaw CS, Sobel JD. Current treatment of bacterial vaginosis-limitations and need for innovation. J Infect Dis. 2016;214(Suppl 1):S14–20.PubMedPubMedCentralGoogle Scholar
  127. 127.
    Verstraelen H, Swidsinski A. The biofilm in bacterial vaginosis: implications for epidemiology, diagnosis and treatment. Curr Opin Infect Dis. 2013;26:86–9.PubMedGoogle Scholar
  128. 128.
    Ferreira CST, et al. Treatment failure of bacterial vaginosis is not associated with higher loads of Atopobium vaginae and Gardnerella vaginalis. J Med Microbiol. 2017;66:1217–24.PubMedGoogle Scholar
  129. 129.
    Alves P, Castro J, Sousa C, Cereija TB, Cerca N. Gardnerella vaginalis outcompetes 29 other bacterial species isolated from patients with bacterial vaginosis, using in an in vitro biofilm formation model. J Infect Dis. 2014;210:593–6.PubMedGoogle Scholar
  130. 130.
    Marrazzo JM, Thomas KK, Fiedler TL, Ringwood K, Fredricks DN. Relationship of specific vaginal bacteria and bacterial vaginosis treatment failure in women who have sex with women. Ann Intern Med. 2008;149:20–8.PubMedPubMedCentralGoogle Scholar
  131. 131.
    Bunge KE, Beigi RH, Meyn LA, Hillier SL. The efficacy of retreatment with the same medication for early treatment failure of bacterial vaginosis. Sex Transm Dis. 2009;36:711–3.PubMedGoogle Scholar
  132. 132.
    Sobel JD, et al. Suppressive antibacterial therapy with 0.75% metronidazole vaginal gel to prevent recurrent bacterial vaginosis. Am J Obstet Gynecol. 2006;194:1283–9.PubMedGoogle Scholar
  133. 133.
    McClelland RS, et al. Improvement of vaginal health for Kenyan women at risk for acquisition of human immunodeficiency virus type 1: results of a randomized trial. J Infect Dis. 2008;197:1361–8.PubMedPubMedCentralGoogle Scholar
  134. 134.
    Mehta SD. Systematic review of randomized trials of treatment of male sexual partners for improved bacteria vaginosis outcomes in women. Sex Transm Dis. 2012;39:822–30.PubMedGoogle Scholar
  135. 135.
    Reichman O, Akins R, Sobel JD. Boric acid addition to suppressive antimicrobial therapy for recurrent bacterial vaginosis. Sex Transm Dis. 2009;36:732–4.PubMedGoogle Scholar
  136. 136.
    Heczko PB, et al. Supplementation of standard antibiotic therapy with oral probiotics for bacterial vaginosis and aerobic vaginitis: a randomised, double-blind, placebo-controlled trial. BMC Womens Health. 2015;15:115.PubMedPubMedCentralGoogle Scholar
  137. 137.
    Xie HY, et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev. 2017;11:CD010496.PubMedGoogle Scholar
  138. 138.
    Verstraelen H, Verhelst R, Roelens K, Temmerman M. Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review. BMC Infect Dis. 2012;12:148.PubMedPubMedCentralGoogle Scholar
  139. 139.
    Gardner HL. Desquamative inflammatory vaginitis: a newly defined entity. Am J Obstet Gynecol. 1968;102:1102–5.PubMedGoogle Scholar
  140. 140.
    Oates JK, Rowen D. Desquamative inflammatory vaginitis. A review. Genitourin Med. 1990;66:275–9.PubMedPubMedCentralGoogle Scholar
  141. 141.
    Lima-silva J, Tavares S, Vieira-baptista P, Beires J. Desquamative inflammatory vaginitis. Acta Obstét Ginecol Port. 2016;10:317–25.Google Scholar
  142. 142.
    Donders GG, Bellen G, Grinceviciene S, Ruban K, Vieira-Baptista P. Aerobic vaginitis: no longer a stranger. Res Microbiol. 2017;168(9–10):845–58. Scholar
  143. 143.
    Mitchell C, Fredricks D, Agnew K, Hitti J. Hydrogen peroxide-producing lactobacilli are associated with lower levels of vaginal interleukin-1β, independent of bacterial vaginosis. Sex Transm Dis. 2015;42:358–63.PubMedPubMedCentralGoogle Scholar
  144. 144.
    Marconi C, et al. Sialidase activity in aerobic vaginitis is equal to levels during bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol. 2013;167:205–9.PubMedGoogle Scholar
  145. 145.
    Donders GGG, Vereecken A, Bosmans E, Spitz B. Vaginal cytokines in normal pregnancy. Am J Obstet Gynecol. 2003;189:1433–8.PubMedGoogle Scholar
  146. 146.
    Vieira-Baptista P, et al. Wet mount characterization of the vaginal flora of HIV women. In: 2nd ISIDOG meeting; 2017.Google Scholar
  147. 147.
    Geng N, et al. Analysis of the risk factors for aerobic vaginitis: a case-control study. Gynecol Obstet Investig. 2015.
  148. 148.
    Iwata T, et al. Cytokine profile in cervical mucosa of Japanese patients with cervical intraepithelial neoplasia. Int J Clin Oncol. 2015;20:126–33.PubMedGoogle Scholar
  149. 149.
    Donders GGG, et al. Increased vaginal pH in Ugandan women: what does it indicate? Eur J Clin Microbiol Infect Dis. 2016;35:1297–303.PubMedGoogle Scholar
  150. 150.
    Wang Z-L, et al. Diagnosis and microecological characteristics of aerobic vaginitis in outpatients based on preformed enzymes. Taiwan J Obstet Gynecol. 2016;55:40–4.PubMedGoogle Scholar
  151. 151.
    Witkin SS. Lactic acid alleviates stress: good for female genital tract homeostasis, bad for protection against malignancy. Cell Stress Chaperones. 2017;23(3):297–302. Scholar
  152. 152.
    Soares R, Vieira-Baptista P, Tavares S. Cytolytic vaginosis: an underdiagnosed pathology that mimics vulvovaginal candidiasis. Acta Obstet Ginecol Port. 2017;11:106–12.Google Scholar
  153. 153.
    Witkin SS, et al. Influence of vaginal bacteria and D- and L-lactic acid isomers on vaginal extracellular matrix metalloproteinase inducer: implications for protection against upper genital tract infections. MBio. 2013;4:e00460–13.PubMedPubMedCentralGoogle Scholar
  154. 154.
    Giraldo PC, et al. Influência da freqüência de coitos vaginais e da prática de duchas higiênicas sobre o equilíbrio da microbiota vaginal. Rev Bras Ginecol Obstet. 2005;27:257–62.Google Scholar
  155. 155.
    Vieira-Baptista P, Lima-Silva J, Beires J, Donders G. Cytolytic Vaginosis does not have an impact on human papilloma virus (HPV) infection and cervical dysplasia. Int J Low Genit Tract Dis. 2017;21:S27.Google Scholar
  156. 156.
    Vieira-Baptista P, Lima-Silva J, Xavier J, Beires J, Donders G. Vaginal Flora influences the risk of Vulvodynia. J Low Genit Tract Dis. 2017;21:S26.Google Scholar
  157. 157.
    Ventolini G, Gygax SE, Adelson ME, Cool DR. Vulvodynia and fungal association: a preliminary report. Med Hypotheses. 2013;81:228–30.PubMedGoogle Scholar
  158. 158.
    Horowitz BJ, Mårdh PA, Nagy E, Rank EL. Vaginal lactobacillosis. Am J Obstet Gynecol. 1994;170:857–61.PubMedGoogle Scholar
  159. 159.
    Cibley LJ, Cibley LJ. Cytolytic vaginosis. Am J Obstet Gynecol. 1991;165:1245–9.PubMedGoogle Scholar
  160. 160.
    Platz-Christensen JJ, Påhlson C, Larsson PG. Long, uniform lactobacilli (Döderlein’s Bacteria): a new risk factor for postoperative infection after first-trimester abortion. Infect Dis Obstet Gynecol. 1995;3:102–9.PubMedPubMedCentralGoogle Scholar
  161. 161.
    Ventolini G. Vaginal leptothrix: from fungi to lactobacillosis. J Genit Syst Disord. 2015;4.
  162. 162.
    Cepický P, Malina J, Kuzelová M. Treatment of aerobic vaginitis and clinically uncertain causes of vulvovaginal discomfort. Ceska Gynekol. 2003;68:439–42.PubMedGoogle Scholar
  163. 163.
    Vieira-Baptista P, Marchitelli C, Haefner HK, Donders G, Pérez-López F. Deconstructing the genitourinary syndrome of menopause. Int Urogynecol J. 2017;28:675–9.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Pedro Vieira-Baptista
    • 1
  • Jacob Bornstein
    • 2
  1. 1.Lower Genital Tract Unit, Gynaecolgy and Obstetrics DepartmentCentro Hospitalar de São JoãoPortoPortugal
  2. 2.Department of Obstetrics and Gynecology Galilee Medical Center, Bar-Ilan University Faculty of MedicineNahariyaIsrael

Personalised recommendations