How to diagnose and treat aerobic and desquamative inflammatory vaginitis

Mason, Mark; Winter, Andrew

doi:10.1136/sextrans-2015-052406

Cited by 21 publications

(14 citation statements)

References 12 publications

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“…8 Clinical manifestations and complications Table 2 summarizes the clinical features of AV/DIV ( Figure 1) and makes note of the important differentials to be considered with DIV. 4,7,8,11,13,14,34,35 No significant differences in clinical findings have been seen between single AV and mixed AV infections and an aid of laboratory work-up is required to distinguish between them. 16 Table 3 enumerates the salient differences between AV and BV.…”

Section: Etiology and Suspected Pathogenesismentioning

confidence: 99%

Aerobic vaginitis – An underdiagnosed cause of vaginal discharge – Narrative review

Sonthalia¹,

Aggarwal²,

Das

et al. 2020

Int J STD AIDS

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The concept of vaginal dysbiosis was for long considered synonymous with bacterial vaginosis (BV), which is characterized by a homogenous non-inflammatory vaginal discharge. The inflammatory variant of vaginal dysbiosis, called aerobic vaginitis (AV), has remained unknown to a large part of the global dermatology and venereology community, gynaecologists and reproductive tract infection specialists with consequential under diagnosis. AV significantly differs from BV, in clinical presentation, diagnostic criteria and management. The deleterious impact of untreated AV on pregnancy merits discussion. Understanding AV is also crucial for better comprehension of desquamative inflammatory vaginitis (DIV), the most severe form of the same entity. We review the condition’s epidemiology, risk factors and suspected aetiology, symptoms and signs, and the latest evidence-backed approach to diagnosis and treatment. The ideal diagnostic approach and treatment for AV/DIV are yet to be established. The currently recommended diagnostic approach for AV/DIV merits an overhaul by incorporating changes to render it feasible for resource-constraint countries. The diagnostic criteria lack a uniform applicability in different physiological groups of women and cannot be used in postpartum or postmenopausal states at the same cut-off levels. Similarly, treatment guidelines merit a relook, and customization, given the equivocality of options suggested by different investigators.

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Section: Etiology and Suspected Pathogenesismentioning

confidence: 99%

Aerobic vaginitis – An underdiagnosed cause of vaginal discharge – Narrative review

Sonthalia¹,

Aggarwal²,

Das

et al. 2020

Int J STD AIDS

View full text Add to dashboard Cite

show abstract

“…In one study, 5% of women presenting with vaginal discharge had AV scores of 5 and over. 8 However, these were a very heterogeneous group and specific pathologies such as atrophic change, lichen planus, and lichen sclerosus should be identified and treated appropriately.…”

Section: Av/divmentioning

confidence: 99%

2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge

Sherrard

Wilson

Donders³

et al. 2018

Int J STD AIDS

202

149

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Four common pathological conditions are associated with vaginal discharge: bacterial vaginosis, aerobic vaginitis, candidosis, and the sexually transmitted infection, trichomoniasis. Chlamydial or gonococcal cervical infection may result in vaginal discharge. Vaginal discharge may be caused by a range of other physiological and pathological conditions including atrophic vaginitis, desquamative inflammatory vaginitis, cervicitis, and mucoid ectopy. Psychosexual problems may present with recurrent episodes of vaginal discharge and vulval burning. These need to be considered if tests for specific infections are negative. Many of the symptoms and signs are non-specific and a number of women may have other conditions such as vulval dermatoses or allergic and irritant reactions.

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“…High resolution studies evaluating relationships between chemokine/cytokines and specific types of communities or member bacterial taxa associated with BV have found that larger proportions of Prevotella and other microbes were associated with a more pro-inflammatory phenotype and increased risk of adverse health outcomes (Anahtar et al, 2015;Gosmann et al, 2017;Lennard et al, 2017;Shannon et al, 2017;Fettweis et al, 2019). However, in general, high levels of neutrophils present in vaginal secretions is indicative of other conditions such as "desquamative inflammatory vaginitis" or "aerobic vaginitis" (Donders et al, 2002;Mason and Winter, 2017). Finally, we emphasize that not all cases BV are characterized by the same signs/symptoms or the presence of clue cells and no single species is a universal marker of BV (Srinivasan et al, 2012).…”

Section: Historical Context and Current Controversiesmentioning

confidence: 99%

Gardnerella vaginalis as a Cause of Bacterial Vaginosis: Appraisal of the Evidence From in vivo Models

Morrill

Gilbert

Lewis

2020

Front. Cell. Infect. Microbiol.

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Koch's postulates dictate the use of experimental models to illustrate features of human disease and provide evidence for a singular organism as the cause. The underlying cause(s) of bacterial vaginosis (BV) has been debated in the literature for over half a century. In 1955, it was first reported that a bacterium now known as Gardnerella vaginalis may be the cause of a condition (BV) resulting in higher vaginal pH, thin discharge, a fishy odor, and the presence of epithelial cells covered in bacteria. Here we review contemporary and historical studies on BV with a focus on reports of experimental infections in human or animal models using Gardnerella vaginalis. We evaluate experimental evidence for the hypothesis that G. vaginalis is sufficient to trigger clinical features of BV or relevant health complications associated with the condition. Additionally, we evaluate in vivo models of co-infection employing G. vaginalis together with other bacterial species to investigate evidence for the hypothesis that G. vaginalis may encourage colonization or virulence of other potential pathogens. Together, these studies paint a complex picture in which G. vaginalis has both direct and indirect roles in the features, health complications, and co-infections associated with BV. We briefly review the current taxonomic landscape and genetic diversity pertinent to Gardnerella and note the limitations of sequence-based studies using different marker genes and priming sites. Although much more study is needed to refine our understanding of how BV develops and persists within the human host, applications of the experimental aspects of Koch's postulates have provided an important glimpse into some of the causal relationships that may govern this condition in vivo.

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How to diagnose and treat aerobic and desquamative inflammatory vaginitis

Cited by 21 publications

References 12 publications

Aerobic vaginitis – An underdiagnosed cause of vaginal discharge – Narrative review

Aerobic vaginitis – An underdiagnosed cause of vaginal discharge – Narrative review

2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge

Gardnerella vaginalis as a Cause of Bacterial Vaginosis: Appraisal of the Evidence From in vivo Models

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