When it comes to vaginal health, understanding different conditions and their symptoms is crucial for maintaining well-being. Two common but often confusing conditions are aerobic vaginitis (AV) and bacterial vaginosis (BV). 

Both conditions happen when there's a shift in the vaginal microbiome, specifically a decline in protective Lactobacillus, called vaginal dysbiosis.

While aerobic vaginitis and bacterial vaginosis can both cause symptoms like abnormal vaginal discharge or an unpleasant odor, it's crucial to differentiate between the two so you can get the right care.

Keep reading to learn more about AV and BV, how they differ, and how you can diagnose and treat each condition. 

What is aerobic vaginitis (AV)?

Aerobic vaginitis is a less commonly discussed vaginal condition characterized by an imbalance in the vaginal microbiome, specifically an overgrowth of aerobic bacteria. Research suggests 7-12% of women have aerobic vaginitis, but due to how often vaginal infections are misdiagnosed, it’s likely more common. 

Unlike bacterial vaginosis, which is typically associated with an overgrowth of various anaerobic bacteria, aerobic vaginitis is often associated with an increase in aerobic bacteria like Staphylococcus aureus, Escherichia coli, and Enterococcus. This imbalance leads to inflammation and can cause symptoms that overlap with other vaginal infections.

Symptoms of aerobic vaginitis can include:

  • Abnormal vaginal discharge that is yellow or greenish, with a thicker consistency than normal
  • A strong, rotten, or foul vaginal odor
  • Vaginal itching and irritation
  • A burning sensation when you pee
  • Painful sex

Severe AV is known as desquamative inflammatory vaginitis (DIV). DIV is associated with the same aerobic organisms (E. coli, Staphylococcus aureus, group B Streptococcus, and Enterococcus faecalis), but it is characterized by severe vaginal inflammation often accompanied by pain and burning.

What is bacterial vaginosis (BV)?

Bacterial vaginosis is a common condition caused by an imbalance in the normal vaginal flora.

In bacterial vaginosis, protective Lactobacillus species are reduced, and harmful bacteria like Gardnerella vaginalis and Prevotella increase. This shift disrupts the natural acidic environment of the vagina.

Symptoms of BV typically include a thin, gray, or white discharge and a fishy smell that becomes more noticeable after sex. 

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AV vs BV

While both aerobic vaginitis and bacterial vaginosis can cause similar symptoms, there are a few key differences:

  • Cause: While both aerobic vaginitis and bacterial vaginosis happen when there's a shift in the vaginal microbiome, aerobic vaginitis is linked to an overgrowth of aerobic bacteria. Meanwhile, bacterial vaginosis is caused by an overgrowth of anaerobic bacteria.
  • Discharge: Aerobic vaginitis often causes a thicker, yellow-green vaginal discharge, whereas bacterial vaginosis typically results in a thin, grayish discharge with a fishy odor.
  • Odor: Both conditions can cause unpleasant vaginal odor, but the fishy smell is more characteristic of bacterial vaginosis.

Diagnosis and treatment

To check for aerobic vaginitis and bacterial vaginosis, the healthcare provider will perform a physical examination, including a pelvic exam. 

During this exam, they'll take a look inside your vagina with a speculum and check for any signs of infection, such as inflammation or unusual discharge. 

They might also collect a sample of vaginal discharge using a swab, which will then be examined under a microscope to identify the presence of bacteria associated with aerobic vaginitis or bacterial vaginosis.

There's no consensus on how to treat aerobic vaginitis because it depends on the severity of symptoms and the specific bacteria involved. For milder cases, your healthcare provider might recommend antibiotics like clindamycin, kanamycin, and fluoroquinolones, along with vaginal probiotics to restore the vaginal flora.

As for bacterial vaginosis, treatment involves antibiotics such as clindamycin and metronidazole, or alternatives like tinidazole or secnidazole. Keep in mind that metronidazole won't work for aerobic vaginitis, so if it doesn't help, it could be a sign that your symptoms weren't caused by bacterial vaginosis. 

How effective an antibiotic is depends a lot on what specific bacteria is causing the infection. Different antibiotics work better against different bacteria, and some spare the protective bacteria while others don't. If you're dealing with recurring infections, knowing the specific bacteria in your microbiome can help in choosing the right antibiotic.

Aside from treatment, there are some everyday behaviors you can do to reduce your risk of developing aerobic vaginitis and bacterial vaginosis: 

  • Avoid douching and using feminine hygiene products (like scented soaps or vaginal deodorants). Douching upsets the normal balance of bacteria in your vagina.
  • Wipe front to back after going to the toilet.
  • Change your period products within the proper time frame.
  • Practice safe sex and use condoms or dental dams.
  • Cover sex toys with a condom during partnered sex, and wash them with unscented soap/water after each use.
  • Quit smoking

How Evvy’s Vaginal Health Test can help

Understanding whether you have aerobic vaginitis or bacterial vaginosis can be challenging based on symptoms alone. Evvy’s Vaginal Health Test offers a comprehensive solution by analyzing your vaginal microbiome and giving you a high-fidelity breakdown of the bacteria in your vagina, including ones linked to bacterial vaginosis and aerobic vaginitis. 

Based on your results, Evvy provides personalized recommendations for treatment and lifestyle adjustments to help restore and maintain a healthy vaginal microbiome. Eligible users can also order a custom prescription treatment program developed by an Evvy-affiliated provider. 

FAQ

What is BV and AV?

Bacterial vaginosis and aerobic vaginitis are two types of vaginal infections caused by an imbalance of good and bad bacteria in the vagina. The main difference is that bacterial vaginosis is due to too many anaerobic bacteria (like Gardnerella and Prevotella), while aerobic vaginitis is connected with aerobic bacteria (such as Staphylococcus aureus, E. coli, and Enterococcus). Both conditions cause unusual vaginal discharge, but with bacterial vaginosis, the discharge is typically thin, gray, and smells fishy. On the other hand, with aerobic vaginitis, the discharge can be sticky, yellow, or green and has a foul or "rotten" smell. Aerobic vaginitis can also lead to irritation, itching, and a burning feeling when you pee.

How do I know if I have AV infection?

If you suspect you might have aerobic vaginitis, keep an eye out for symptoms like a thick, yellow or greenish discharge, a strong, unpleasant smell, and any itching or burning around the vaginal area. Since these symptoms can be similar to those of other vaginal infections, it's best to visit a healthcare provider for an accurate diagnosis. Your provider will carry out a pelvic exam, take a sample of vaginal discharge, and perform a microscopic analysis to identify any aerobic bacteria. They might also test for other conditions (like bacterial vaginosis or sexually transmitted infections) to exclude any other causes. Alternatively, you can take an Evvy Vaginal Health Test, which tests for over 700 bacteria and fungi, including ones linked to aerobic vaginitis.

Can you have BV and AV at the same time?

Yes, it is possible to have both bacterial vaginosis and aerobic vaginitis at the same time. Both conditions are caused by an imbalance in the vaginal microbiome, but they're linked to different types of bacteria.

Can metronidazole treat AV?

While metronidazole is commonly used to treat bacterial vaginosis, it's not effective in treating aerobic vaginitis. Aerobic vaginitis is usually linked to an overgrowth of aerobic bacteria like Staphylococcus aureus and E. coli, and metronidazole primarily targets anaerobic bacteria. Treatment for aerobic vaginitis often involves antibiotics that work against aerobic bacteria, such as clindamycin. If you think you might have aerobic vaginitis, it's super important to chat with a healthcare provider for an accurate diagnosis and a treatment plan tailored to your condition. Your healthcare provider will figure out the best antibiotics or treatment strategies based on your symptoms and test results. Alternatively, you can get treatment for aerobic vaginitis with Evvy's Clinical Care platform.