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![Comparison between pure and mixed aerobic infections (n[n%])](publication/342570387/figure/tbl3/AS:908183266668546@1593539172529/Comparison-between-pure-and-mixed-aerobic-infections-nn_Q320.jpg)
Background:
Aerobic vaginitis (AV) is a reproductive tract infection that affects health of women. The objective of this study was to analyze the characteristics of simple and mixed AV patients in Xi'an district and provide reference data for the clinical treatment of AV.
Methods:
Patients were recruited from the outpatient Department of Obstetr...
Context in source publication
Context 1
... in accordance with the Chinese expert consensus on the clinical application of vaginal microecological assessment from 2016, AV was assessed and diagnosed using Donders' score in the present study [14]. Diagnostic criteria and the corresponding AV scores are displayed in Table 1. Scores of 0 to 10 were assigned to each sample, representing different levels of bacterial flora, epithelial disruption, and inflammation: 0-2 (no AV), 3-4 (mild AV), 5-6 (moderate AV), or 7-10 (severe AV). ...Citations
... When the healthy state of the microbiota becomes displaced due to a compromised immunity, ill-health, antibiotic uses etc.; the unique low microbial diversity, the Lactobacilli predominance status and lactic acid protection are lost, with resultant overgrowth of opportunistic bacteria. This condition is known as dysbiosis and results in a variety of vaginal infections and conditions such as vulvovaginal candidiasis (VVC), bacterial vaginosis (BV), trichomonasis, cytolytic vaginosis (CV) or aerobic vaginitis (AV), abnormal leucorrhea, increased discharge, vulval itching and burning pain (Zhang et al, [7] Serretiello et al . [8]; Yasin et al,. ...
... (Zhang e et al,. [7] Oerlemans et al,. [10] It has remained beclouded with difficulties in diagnosis and choice of antibiotics due to increasing incidence of antimicrobial resistance, and these have adversely affected its treatment for long. ...
... Zhang et al,. [7]. The prevalence of 31.4% obtained in this study is higher than the figures reported in a number of studies such as the range of 7.9-23.7%¸ ...
The vaginal microbiota, unlike some other sites such as the intestinal microbiota is a less diversified micro-ecosystem; dominated normally by Lactobacilli which play specific important roles in the wellbeing of the vagina and the female person. Dysbiosis or the loss of Lactobacilli dominance results in ecological shift that leads to a number of conditions such as proliferation of intestinal aerobic bacteria leading to aerobic vaginitis and such other disease conditions. In this retrospective cross sectional descriptive study, laboratory records of microscopy, culture and susceptibility analysis of high vaginal swabs (HVS) and other relevant data were reviewed to synthesize information relating to the microbial community and antimicrobial resistance among aerobic bacteria. Out of 790 specimens examined, microbial growths were observed in 596 (75.4%); dominated by fungi (Candida spp), 485 (68.3%), followed by aerobic bacteria, 223(31.4%) and protozoa (Trichomonas), 2 (0.3%). The bacterial population was dominated by Escherichia coli 98 (44.0%), followed by Enterococcus faecalis 55 (24.7%), Staphylococcus aureus 41 (18.4%), Proteus mirabilis 10(4.5%), Streptococcus agalactiae 9 (4.0%), Klebsiella pnumoniae 5 (2.2%) and Pseudomonas aeruginosa 10 (4.5%). Gram negative bacteria constitutes 118 (52.9%), while gram positive are 105 (47.1%) The cumulative antimicrobial resistance profile of the 223 bacterial strains tested against 10 antimicrobial agents was 55.5%. Pseudomonas aeruginosa was the most resistant bacteria by showing resistance against 62% of the test antimicrobial agents, followed by Klebsiella pnumoniae, 58%, Escherichia coli, 54.1%, Staphylocuccus aureus, 51.0%, Proteus mirabilis, 51.0%. Enterocuccus faecalis, 48.4% and Streptococcus agalactiae 38.9%. This study has contributed in ascertaining the prevalence of bacterial and other associated organisms of the vaginal microbiota, and also unraveled the different aerobic bacterial species together with their antimicrobial resistance patterns; which will be found valuable in treatment of associated infections.
... [8]. Zhang et al. [23] showed that 65.5% had a single infection among patients with AV. In this study, mixed bacteria had the highest detection rate in the single infection, accounting for 79.06% of all infection cases. ...
Background
To explore the pathogen distribution in Chinese females with vaginitis.
Methods
This retrospective study included Chinese females with vaginitis admitted at the outpatient department of the Gynecology Clinic of the Second Affiliated Hospital of Kunming Medical University between January 2013 and June 2013. Data on the vaginal pathogens and inflammation were analyzed.
Results
The vaginal secretions from 15,601 gynecologic outpatients were abnormal, including 8547 (54.78%) with vaginal infection and 7054 (45.22%) without. In patients with vaginal infections, a single infection was observed in 69.72% (5959/8547) of them, and mixed infection was observed in 30.28% (2588/8547). The differences in age and inflammation grade between the infection and no-infection groups were statistically significant (all P < 0.001). In addition, multiple types of vaginitis could be diagnosed in patients with mixed infections.
Conclusions
About half of the Chinese women with abnormal vaginal secretions are positive for pathogens in the study period. Patients’ age and inflammation grade are associated with co-infection. From the public health perspective, this study suggests that the importance of vaginal hygiene should be enforced in Chinese women.
... 17 Zhang et al. diagnosed 186 women with AV and an additional 98 with mixed infections including AV, but did not mention the total number of investigated women with discharge or complaints. 18 They used the scoring system proposed by Donders et al. or the Tempera criteria (abnormal yellow discharge; foul smell, but negative whi test; pH >5; abundant vaginal leukocytes). 19 The inclusion criteria were as follows: being sexually active, age 19-50 years, Han ethnicity, diagnosis of AV either isolated or in context of a "mixed infection". ...
In most papers and textbooks, it is still considered that “vaginitis” are limited to candidiasis or candidosis, bacterial vaginosis (BV), and trichomoniasis. Not surprisingly, some studies report a rate of “unspecific vaginitis” that can be as high as 30%.1 This high rate derives from both insufficient diagnostic workup, but also from the non-acknowledgment of other entities, such as aerobic vaginitis/desquamative inflammatory vaginitis (AV/DIV) and cytolytic vaginosis (CV). These remain controversial and are not universally accepted. Nevertheless, they need to be discussed and listed among possible cases of vaginitis; this will foster investigation and publication on the topic.
... Because of the high proportion (68.51%) of AV patients combined with the other vaginitis in this study, and mainly combined with BV, we suggest that different pathogens influenced each other, which may have affected the interpretation of their correlation. Increasingly, studies have shown a higher incidence of AV-related mixed vaginitis (30,31), and the relationship between AV itself and HPV infection requires further investigation. ...
Background
Vaginal microecology has a definite influence on human papillomavirus (HPV) infection and clearance, but the specific correlation is still controversial. This research aimed to investigate the differences in the vaginal microenvironment of different types of HPV infection and also provide data supporting clinical diagnosis and treatment.
Methods
According to strict inclusion and exclusion criteria, the case data of 2,358 female patients who underwent vaginal microecology and HPV-DNA tests at the same time in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Xi'an Jiaotong University from May 2021 to March 2022 were retrospectively analyzed. The population was divided into two groups: an HPV-positive group and an HPV-negative group. HPV-positive patients were further classified into HPV16/18-positive group and HPV other subtypes positive group. The vaginal microecology of HPV-infected patients was analyzed using the chi-square test, Fisher's exact test, and logistic regression.
Results
Among the 2,358 female patients, the HPV infection rate was 20.27% (478/2,358), of which the HPV16/18 infection rate was 25.73% (123/478), and the HPV other subtypes infection rate was 74.27% (355/478). The difference in HPV infection rates between the age groups was statistically significant (P < 0.01). The prevalence of mixed vaginitis was 14.37% (339/2,358), with bacterial vaginosis (BV) paired with aerobic vaginitis (AV) accounting for the majority (66.37%). The difference in HPV infection rates among mixed vaginitis was not statistically significant (P > 0.05). The prevalence of single vaginitis was 24.22% (571/2,358), with the most frequent being vulvovaginal Candidiasis (VVC; 47.29%, 270/571), and there was a significant difference in HPV infection rates among single vaginitis (P < 0.001). Patients with BV had a higher risk of being positive for HPV16/18 (OR: 1.815, 95% CI: 1.050–3.139) and other subtypes (OR: 1.830, 95% CI: 1.254–2.669). Patients with Trichomoniasis were at higher odds of other HPV subtype infections (OR: 1.857, 95% CI: 1.004–3.437). On the contrary, patients with VVC had lower odds of becoming infected with other HPV subtypes (OR: 0.562, 95% CI: 0.380–0.831).
Conclusion
There were disparities in HPV infection among different age groups; therefore, we should pay attention to the prevention and treatment of susceptible individuals. BV and Trichomoniasis are linked to HPV infection; hence, restoring the balance of vaginal microecology could assist in the prevention of HPV infection. As a protective factor for other HPV subtype infections, VVC may provide new insights into the development of immunotherapeutic therapies.
... (9) Most of the symptomatic patients self-medicate before seeking an evaluation by a medical professional, because complementary, alternative therapies and over-the-counter medications are available in a varied range. (10,11) Prevention of infection should include avoiding long-term use of antibiotics and a clear contraindication to frequent vaginal douching. (12) Recurrence of vaginosis is really frequent, and can include four or more episodes in one year. ...
A collection of clinical data was conducted to assess the performance and tolerability of Cerviron ovules in the treatment and management of various types of vaginitis in clinical practice. A total of 111 women aged between 20 and 70 years were included, 71 of whom were treated with Cerviron ovules as monotherapy and 40 who used Cerviron ovules as supportive treatment in conjunction with antibiotic therapy. The aim of our study was to assess the relief in vaginal symptoms and changes in the normal vaginal pH level after 3 months of treatment with Cerviron medical device in real-life clinical practice settings. The results showed that Cerviron ovules are well tolerated and effective as monotherapy and also as an adjuvant to antibiotic therapy. The study and its details are registered in www.clinicaltrials.gov under ID NCT05652959 .
... A recent study underlines the fact that the prevalence of aerobic vaginitis among pregnant women is four-times higher than in nonpregnant women [28]. As such, early diagnosis and treatment of aerobic vaginitis or its relapse before and during pregnancy are very important to reduce severe complications. ...
Purpose
Non-specific vaginitis is a distinct clinical entity with particular microscopic and immunologic features. Currently, there is no standard of care for women with non-specific vaginitis. The aim of our study was to assess the change in vaginal symptoms score after a 3-months treatment with Cerviron medical device in participants with abnormal vaginal discharge and with specific signs and symptoms. As secondary objectives, the study analyzed other clinical and microscopic features, such as vaginal discharge aspect, change in vaginal pH, change in vaginal microbiome, and vaginal inflammation.
Methods
The study population included 47 participants suffering from symptomatic vulvovaginitis, distinct from candidiasis, trichomoniasis or bacterial vaginosis. The study design included 2 research sites from Romania. The treatment protocol consisted of 1 ovule/day inserted intravaginally, during 15 consecutive days. The total study duration was 3 months.
Findings
Cerviron had a positive impact on the vaginal symptoms score for 72.34% of the study participants. Topical administration of Cerviron balanced vaginal pH values and significantly reduced signs of inflammation between study visits.
Implications
Cerviron shows curative effects that supports its use as a stand-alone treatment in women with
non-specific vaginitis. ClinicalTrials.gov identifier: NCT04735705.
A second clinical investigation is ongoing to evaluate its clinical efficacy in postoperative care of cervical and vaginal wounds, traumatic or secondary to surgical interventions.
... AV patients were distributed into four age groups: ≤ 20 years in 13 (14.60) cases, (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) The mean±SE (standard error) and the probability P value of patients' age according to the pathogenic bacterial type were determined as shown in (Table 4); the diversity of AV bacteria according to the age group was significantly different, and the results indicate that the age (p= 0.02, CI 95%) was considered a significant factor in women infected with Micrococcus spp and Enterococcus spp, also in wo-men infected with Staphylococcus spp and P.aeruginosa (p= 0.05, CI 95%). While in women infected with Kocuria spp., E.coli and K.pneumoniae (P value =NS), the age was considered statistically non-significant. ...
... As shown in (Figure 2), most (46.06%) of AV-infected women belonged to the age group (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) years; this finding is in agreement with a study conducted by Wang et al. 14 when they found that the AV was usually isolated from the sexually active patients age group of 20-30 years, followed by those in the age group of 30-40 years. The highest prevalence in the age groups (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and (31-40) may perhaps be due to these being the highest reproductively active and high sexual exposure groups. ...
... As shown in (Figure 2), most (46.06%) of AV-infected women belonged to the age group (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) years; this finding is in agreement with a study conducted by Wang et al. 14 when they found that the AV was usually isolated from the sexually active patients age group of 20-30 years, followed by those in the age group of 30-40 years. The highest prevalence in the age groups (21)(22)(23)(24)(25)(26)(27)(28)(29)(30) and (31-40) may perhaps be due to these being the highest reproductively active and high sexual exposure groups. A study conducted by Zhang et al. 29 reported that simple AV patients were aged > 50 years, while mixed AV patients were aged 30-40 years and also found that age was a significant factor in AV infections (p=0.003); this result is in agreement with the results of the present study when age is a significant factor in associated with most AV bacterial types. ...
Aerobic vaginitis (AV) is a newly adopted type of vaginal infection caused by aerobic bacteria; it was defined by Donders in 2002 and diagnosed according to Donder's criteria. AV is associated with increased vaginal pH, decreased vaginal microbiota and overgrowth of facultative anaerobic or aerobic bacteria, including Gram-positive cocci and Gram-negative bacilli. Because knowledge of the aerobic bacterial types causing AV is very important and only limited studies are available in Iraq about this type of vaginal infection, this study aimed to report the prevalence of AV in symptomatic women in Baghdad City, investigate the aerobic bacterial types associated and to evaluate the most critical symptoms and risk factors associated with AV. One hundred fifteen high vaginal swabs (HVSs) and 115 vaginal swabs (VSs) were collected from women of age 18-50 years attending some hospitals and private clinics in Baghdad City under the supervision of a competent gynecologist. Vaginal swabs were prepared for direct wet mount preparation to test under the microscope and Gram staining for AV identification according to Donders Criteria. High vaginal swabs were cultured on different culture media; the primary diagnosis of obtained colonies was based on phenotypic characteristics, conventional biochemical tests and Gram staining. The diagnosis was confirmed using Gram-positive (GP) and Gram-negative (GN) identification cards of the VITEK 2 System. Statistical analysis was carried out using (SPSS v 20) and p-value ≤ 0.05 at 95% CI was considered statistically significant. Out of the 115 swabs, only 89 (77.3%) swabs showed bacterial growth. Ninety-five bacterial isolates were obtained, including (65.2%) Gram-positive and (34.7%) Gram-negative bacteria. G+ve bacterial isolates included: (46.3%) Staphylococcus spp., (6.3%) Kocuria spp., (6.3%) Enterococcus spp., (5.2%) Micrococcus luteus and (1.0%) of Streptococcus agalactiae. G-ve bacterial isolates included (15.7%) Escherichia coli, (11.2%) Klebsiella pneumoniae, (3.2%) Pseudomonas aeruginosa (3.2%) Pseudomonas aeruginosa, (2.1%) Acinetobacter baumannii and (2.1%) Proteus mirabilis. More than half (58.4%) of patients showed severe AV. Mixed bacterial infections were reported in 6 (6.7%) cases only. Vaginal pH ranged between (5.5- 6.5). The most frequent(100%) testified symptoms were abnormal vaginal discharge and itching, or irritation, the less frequent symptoms (51.6%) was vaginal dyspareunia, and the most significant symptoms in associated with different bacterial types and age groups were foul smelling and burning (p= 0.001, 0.008, 0.0001). Among the risk factors, age was significantly associated with most bacterial types obtained with p values (0.05 and 0.02). Staphylococcus spp. and E.coli were the predominant bacterial types in AV patients in the current study, and the lower rate of bacteria was Streptococcus agalactiae (1.0%). A high prevalence of AV was reported; therefore, regular screening and proper diagnosis of AV using microscopic examinations, culturing of swabs and determining vaginal pH using specific vaginal pH test strips should be stimulated to develop AV management. Keywords: High vaginal swabs, Vaginal swabs, Aerobic vaginitis, aerobic G+ve and G-ve bacteria, Risk factors, Iraq.
... Bacterial vaginosis was reported in literature as the most prevalent vaginal infection, with an approximate 50 % of the total cases of vaginal infections [9]. Most of the symptomatic patients self-medicate before seeking an evaluation by a medical professional, because complementary, alternative therapies and over-the-counter medications are available in a varied range [10,11]. Prevention of infection should include avoiding long-term use of antibiotics and a clear contraindication to frequent vaginal douching [12]. ...
... A study in Bulgaria has found that the prevalence of AV, in general, was 11.77%, in pregnant women was 13.08%, and in non-pregnant women was 4.34%, with the most age group being 21-30 years old (32.3%) [4]. This kind of condition is quite concerning because AV can cause various secondary infections that lead to severe conditions such as spontaneous abortion, chorioamnionitis, membranes rupture early, early labor, infertile, also PID [5]. ...
... Statistically, there was a difference in the mean and standard deviation of the vaginal pH levels of rats before administration of the ethanol extract of Streptococcus agalactiaeplant, the results are shown in Table 1: The high level of vaginal pH in AV rats before administration of the ethanol extract of the Centella asiatica in this study proves that the decrease in the number of Lactobacillus, which is one of the signs of AV, is associated with an increase in vaginal pH, which is similar to the results of several other studies [47,48]. One study stated that although it was difficult to clearly distinguish simple AV and mixed AV based on pH levels, there was a pH level higher than 4.5 in AV patients due to lower lactobacillus levels [5,49]. This result is supported by statistical data on the average pH levels of the negative control group and the positive control group's pH levels which are depicted in the diagram below: ...
Aerobic vaginitis (AV) is an infection in the vagina with a high inflammatory response, decreased Lactobacillus sp., increased pathogenic bacteria, increased parabasal cells, and increased acidity levels (pH). Increased pH levels in AV conditions are associated with reduced Lactobacillus in the vagina due to the dominance of aerobic or anaerobic bacteria that cause AV, including Streptococcus agalactiae, which can cause an increased risk of infection. Antibiotics are the mainstay of AV treatment but are resistant to several antibiotics, causing the need for other alternatives, one of which is the use of medicinal plants. The medicinal plant in this study is Centella asiatica plant which has been proven to have an anti-bacterial property. This study aims to compare pH levels before and after administration of ethanol extract of Centella asiatica on the acidity (pH) levels of Rats in AV model. This research is an experimental study use post-test control group only, consists of six groups Rattus norvegicus female. The first group was the negative control group (K-) rats. The second group was positive control rats (K+). The next are four groups of rats of AV models given various doses of ethanol extract of Centella asiatica, and each group consists of four rats, namely P1 (100 mg/kg). P2 group (200 mg/kg), P3 (400 mg/kg), and P4 (800 mg/kg). Paired T-Test showed results P-value is 0.000 (<0.005), stating that there was a significant difference between pH levels both before and after administration of ethanol extracts of Centella asiatica plant in rats model AV.
... These selected variables were based on the literature. 4,6,7,[16][17][18][19][20] ...
... 6 A high AV prevalence has been postponed in China (65.49%) among sexually active patients who underwent routine gynecological examination. 18 AV is a common form of vaginal infection that is distinguished from BV. The microflora in AV comprises commensal aerobic microorganisms of intestinal and mucosa origin (Table 3), principally Escherichia coli, Staphylococcus aureus, and Staphylococci. ...
... The microflora in AV comprises commensal aerobic microorganisms of intestinal and mucosa origin (Table 3), principally Escherichia coli, Staphylococcus aureus, and Staphylococci. 3,5,18 Data from our work on outpatients in south-eastern Gabon show that Streptococcus B (23.9%), Staphylococcus aureus (17.7%), Klebsiella spp. ...
Introduction:
Discomfort in women of childbearing age associated with vaginal infections, namely bacterial vaginosis (BV), aerobic vaginitis (AV), vulvovaginal candidiasis (VVC), and trichomoniasis (TV), represent a serious and ongoing gynecological complication throughout the world.
Objective:
This study aimed to investigate the etiologies of vaginal infections among outpatients in south-eastern Gabon.
Methodology:
A cross-sectional study was designed using participants referred directly by their treating doctor for a vaginal swab. Socio-demographic data were collected using a structured questionnaire. Microscopic examinations were used for TV and BV diagnostic. All vaginal swabs were cultured for AV and VVC isolates using standard microbiology methods.
Results:
A total of 573 women of reproductive age participated in the study. The most common identified vaginal infections were BV (62.8%) and AV (51.1%) followed by VVC (34.1%). No significant difference was observed for each etiology compared to socio-demographic data. Streptococcus B (23.9%), Staphylococcus aureus (17.7%), Klebsiella spp. (11.6%), and E. coli (5.8%) were the bacteria most associated with AV. A high incidence of non-C. albicans Candida (NCAC) strains causing vulvovaginitis were found. The prevalence of TV (2.1%) was low. Mixed infections had been common among participants. No association was found with TV and other vaginal infections, unlike others studies. The present study identified BV 228 (83.5%) and AV 227 (83.2%) as the main cause of mixed infections. The mixed infection AV-BV 113 (41.4%) was the most represented.
Conclusion:
Also that simultaneous AV-BV-VVC represented 69 (25.3%) of mixed infections. Molecular analyses would be needed to identify the key species commonly associated with these vaginal infections.
