Aerobic Vaginitis – A Common but Underdiagnosed Cause of Recurrent Vaginal Discharge of Dysbiotic Origin– Are We Dealing with a Cryptic STI?
Hitherto, the concept of vaginal dysbiosis was considered synonymous with Bacterial Vaginosis (BV), characterized by homogenous non-inflammatory vaginal discharge (VD) attributed to the replacement of the normal vaginal flora with pathological bacteria especially Gardnerella vaginalis. Across the globe, any woman in her 3rd to 4th decade of married life presenting with white homogenous minimally symptomatic VD was labelled as BV on finding of reduced lactobacilli, and often the fulfillment of the Amsel’s criteria. However, off late many women with inflammatory variant of BV with recurrence have started presenting to the STI clinic. An inflammatory variant of vaginal dysbiosis caused by group-B streptococci and related organisms presenting with purulent discharge and features of local inflammation was identified in 2002 and labelled aerobic vaginitis (AV) by Gilbert Donders. However, 17 years down the lane, this entity, suspected to be common, remains unknown to with consequential underdiagnosis by reproductive tract infection (RTI) specialists, gynecologists and dermatologists.