Aerobic vaginitis

Vaginitis is a very common gynecological disease. Depending on the cause, vaginitis can be divided into many types, and aerobic bacterial vaginitis is a typical one. Aerobic vaginitis is different from candidal, Trichomonas and bacterial vaginitis, and is easily misdiagnosed, leading to very serious consequences. Only correct treatment can achieve the greatest improvement in the condition. Next, let’s take a look at the situation of aerobic vaginitis.

Antibiotic treatment

Drugs targeting aerobic bacteria (such as Escherichia coli, aerobic enterococci, Staphylococcus aureus, Corynebacterium, and hemolytic Streptococci) can be used to treat AV. There is research to support AV

The patient was treated with systemic topical kanamycin and clindamycin.

In a 1994 retrospective analysis, Sobel et al treated 51 patients with DIV with 2% clindamycin suppositories. Forty-five patients received at least one course of treatment (14 days), 19 of whom were postmenopausal and 16 had previously received hormone replacement therapy. Clinical signs and symptoms improved in most patients after the first treatment, but 17 of them underwent another course of treatment because their wet mount microscopy continued to show abnormal vaginal flora and elevated pH.

In addition, one-third of patients were still found to have abnormal vaginal flora during follow-up. Six postmenopausal patients were considered to have estrogen deficiency, which was cured after estrogen supplementation. In this report, Gram-positive cocci were the common species susceptible to clindamycin.

The researchers evaluated the effectiveness and tolerability of the two drugs 7-8 days and 13-16 days after treatment, respectively. The remission rate was 80% in the chloramphenicol group and 100% in the kanamycin group. In addition, kanamycin is more effective in treating severe AV. During follow-up, only the kanamycin group achieved complete restoration of vaginal homeostasis: vaginal pH returned to normal and lactobacilli were abundant.

In 2006, Tempare et al. reported the treatment of 81 patients with AV. Female patients were treated for AV with vaginal suppositories containing 100 mg kanamycin (n=45) or 36 mg chloramphenicol (n=36) for 6 consecutive days. The researchers evaluated the efficacy of the treatment 1-2 days and 30 days after treatment. A decrease in leukocyte count was noted at the first follow-up visit. In addition, the relief of vaginal mucosal burning and itching was more significant in the kanamycin group than in the chloramphenicol group.

In 2011, Sobel et al. conducted an open study on 98 DIV patients. Of these patients, 53 (54.1%) were treated with topical clindamycin 2%, and 45 (45.9%) were treated with topical intravaginal hydrocortisone 10% 3-5 g/d (n = 39) or cortisone acetate suppositories 25 mg twice daily (n = 6). In this study, 84 patients (85.7%) achieved symptom relief within an average of 3 weeks. Of these, 53 patients (63.1%) had normal wet mounts after 8 weeks and subsequently discontinued treatment.

However, 17 patients (32%) relapsed within 6 weeks, and 23 patients (43.4%) received post-relapse treatment within 26 weeks. After 1 year, 25 patients (26%) were cured. Symptoms were controlled in 57 patients (58%), but they continued to receive treatment. In addition, the researchers found that 15 (16%) patients had only partial control of their symptoms during one-year follow-up.

DIV is a chronic condition and long-term maintenance treatment is often necessary. However, we did not further compare the therapeutic effects of clindamycin and steroids. In 2010, Tempera et al. suggested that the treatment method for AV should take into account the antibacterial spectrum of antibiotics and choose drugs that have no or little interference with the normal vaginal flora. The safest and most effective treatment strategy is to maintain the correct local vaginal drug concentration while minimizing systemic absorption.

In addition to antibiotic therapy, treatment of vaginal infectious diseases should be directed toward the recovery of the vaginal microenvironment and its immunity. Probiotics can promote balance and immune regulation to maintain vaginal homeostasis. Lactobacilli are important for the maintenance of the vaginal environment because these bacteria can fight pathogen colonization by producing lactic acid and hydrogen peroxide and by competitively adhering to vaginal epithelial cells.

For chronic vaginitis (such as AV), it is necessary for doctors to maintain the production of defensive flora through drugs, such as metronidazole, clindamycin or regular application of exogenous lactobacilli (such as monthly use). Long-term and frequent use of antibiotics can cause side effects.

However, exogenous lactobacilli may be a safer option for preventing relapse. Ozkinay et al. studied 360 cases of vaginal infections, including BV, candidiasis, trichomoniasis, and Chlamydia trachomatis, in a randomized, double-blind, sham-controlled clinical trial. Before the study, all patients received 2-3 days of standardized anti-infective treatment and were randomly divided into two groups: 240 patients received Gynoflor (containing 107 L-active Lactobacillus acidophilus and 0.03 mg estriol), and the other 120 patients received placebo only. Patients received suppository therapy for 6 consecutive nights, with treatment extended to 12 days in postmenopausal patients.

The effectiveness of treatment was evaluated 3-7 days and 4-6 weeks after the end of treatment. The overall assessment included vaginal pH, overall score, and counts of lactobacilli, pathogenic microorganisms, and leukocytes. The results showed that the vaginal microenvironment was significantly improved in the group treated with Gyno?or compared with the sham group. Therefore, restoring the vaginal environment after anti-infection is very important to reduce recurrence.