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No. 1: Aerobic Vaginitis SUMMER 2012 | VOLUME 5 No. 1 | Biyearly Publication Medical Diagnostic Laboratories, L.L.C. Presorted 2439 Kuser Road First-Class Mail U.S. Postage Research & Development Test Announcement Journal Watch Hamilton, NJ 08690 Aerobic Vaginitis Tests now available in the clinical Summaries of recent topical PAID Continued ...................... pg 2 laboratory publications in the medical literature Trenton, NJ Full Article ...................... pg 4 Full Article ...................... pgs 5 Permit 348 SM The Laboratorian WHAT’S INSIDE Aerobic Vaginitis P2 Aerobic Vaginitis Author: Dr. Scott Gygax, Ph.D. Femeris Women’s Health Research Center P3 Aerobic Vaginitis P3 Recent Publications Aerobic vaginitis (AV) is a state of abnormal vaginal flora forms of AV can also be referred to as desquamative that is distinct from the more common bacterial vaginosis inflammatory vaginitis (DIV). (2, 3) P4 e-quiz (BV) (Table 1). AV is caused by a displacement of the BV is a common vaginal disorder associated with the P4 Q&A healthy vaginal Lactobacillus species with aerobic pathogens overgrowth of anaerobic bacteria, a distinct vaginal such as Escherichia coli, Group B Streptococcus (GBS), P4 New Tests Announcement malodorous discharge, but is not usually associated Staphylococcus aureus, and Enterococcus faecalis that trigger with a strong vaginal inflammatory immune response. P5 Journal Watch Research & Development a localized vaginal inflammatory immune response. Clinical Aerobic Vaginitis Like AV, BV also includes an elevation of the vaginal pH signs and symptoms include vaginal inflammation, an itching P6 Classified Ad Continued ...................... pg 2 > 4.5 and a depletion of healthy Lactobacillus species. or burning sensation, dyspareunia, yellowish discharge, BV is treated with traditional metronidazole therapy that and an increase in vaginal pH > 4.5, and inflammation with targets anaerobic bacteria. However, approximately leukocyte infiltration. (1) Severe, persistent, or chronic Test Announcement 10% to 20% of women diagnosed with BV and treated UPCOMING EVENTS Tests now available in the clinical Table 1. with metronidazole will fail to respond to therapy at one laboratory A Comparison of Bacterial Vaginosis and Aerobic Vaginitis. 10/3-7 PCOGS: Pacific Coast Full Article ...................... pg 4 week and will experience persistent symptoms. (4, 5) Clinical Characteristics Bacterial Vaginosis Aerobic Vaginitis (1) It is believed that a subset of these patients may have OBGYN Society Annual SM been misdiagnosed and actually suffer from AV, which Meeting Lactobacilli Displaced Displaced requires an antibiotic therapy with intrinsic activity Newport Beach, CA Journal Watch Escherichia coli, Summaries of recent topical publications Gardnerella Group B against specific aerobic bacteria. AV has been implicated in the medical literature vaginalis, Atopobium Streptococcus, in complications of pregnancy such as ascending Full Article ...................... pgs 5 The Pathogen vaginae, Staphylococcus chorioamnionitis, premature rupture of the membranes, Megasphaera Laboratori aureus, Enterococcus and preterm delivery. an species, BVAB2 faecalis Vaginal epithelial None Present Epidemiology inflammation In a study of 631 patients attending routine prenatal care WorldWide Medical Products, Inc. Elevation of pro- inflammatory cytokines Moderate elevation High elevation from a vaginitis clinic, 7.9% had moderate to severe AV (IL-1β, IL-6, IL-8) signs and symptoms and 6% had ‘full-blown’ BV. (1) Item Number - 71011010 Immune reaction In a study of 3,000 women, 4.3% were found to have Powder-Free Latex Gloves Non-reactive Reactive Item Number - 71011000 1000/case - $48.95 (cytotoxic leukocyte) severe AV, also called DIV. Furthermore, 49.5% of Item Number - 14001003 Powder-Free Nitrile Gloves T= 4.2-4.5 the women with DIV were peri- or postmenopausal. pH [Normal = 3.8 – 4.2] > 4.5; usually >6 Small Vaginal Speculum, Indiv. Wrapped 1000/case - $54.95 BV > 4.5 A reported hypothesis is that a drop in estrogen my 10/pack - $37.95 Shed vaginal epithelial trigger the development of AV in the aforementioned Clue cells Parabasal cells cells menopausal women, as well as postpartum nursing Vaginal discharge women. (3) White, homogenous Yellowish Item Number - 14001004 characteristic Medium Vaginal Speculum, Indiv. Wrapped In a more recent study of 215 women, 19.1% were found 10% KOH Whiff Test 10/pack - $39.95 Positive Negative to have ‘common vaginitis’ caused by BV, vulvovaginal (fishy amine odor) Item Number - 14001005 candidiasis (VVC), or trichomoniasis (TV), whereas Large Vaginal Speculum, Indiv. Wrapped Item Number - 14011002 Kanamycin ovule. (5) 12.6% were found to have ‘inflammatory vaginitis’ (IV). 10/pack - $41.95 Exam Table Rolls, Crepe, 21” x 125’, Of the IV group, 77.8% were characterized as having White 12/case - $24.92 2% clindamycin DIV. (11) In fact, 42.9% of the women with DIV were topical. (3) found to be GBS positive, a 5-fold increase over the healthy patients (17.7% positive). (11) This study was Fluoroquinolones are reported to have similar to an earlier study that found 43% of DIV patients clinical success. (5) were GBS positive. (2) Metronidazole b Item Number - 31031000 Treatment 3” Cotton Tipped Applicator Clindamycin b GBS is uniformly Pathogenesis 1000/box - $3.15 sensitive to penicillin, ampicillin, amoxicillin, AV is associated with an increase in vaginal pH (> Item Number - 31031001 Item Number - 14011006 6” Cotton Tipped Applicator amoxicillin/clavulanic 4.5), depletion of vaginal healthy Lactobacilli, and an Exam Table Rolls, Smooth, 21” x 125’, acid. (7) 1000/box - $4.49 White10/pack - $35.76 overgrowth of aerobic or facultative anaerobic bacteria, usually the Gram-negative bacilli E. coli or Gram- Item Number - 31031005 E. faecalis is traditionally treated positive cocci GBS, and occasionally S. aureus and 51/2” Tongue Depressors Sterile 41021159 10x75- Borosilicate Disposable Culture Tubes- 1000/cs 34.50 with ampicillin. (8) E. faecalis. The high concentration of these aerobic 1000/case - $32.95 41021160 12x75- Borosilicate Disposable Culture Tubes- 1000/cs 38.75 41021161 13x100- Borosilicate Disposable Culture Tubes- 1000/cs 49.25 bacteria and the absence of healthy vaginal Lactobacilli 41021164 16x125- Borosilicate Disposable Culture Tubes- 1000/cs 79.50 References are provided for treatment information; Fluoroquinolones, results in triggering the immune system as evidenced Item Number - 31031006 41021165 16x150- Borosilicate Disposable Culture Tubes- 1000/cs 85.50 such as ciprofloxacin, ofloxacin, and levofloxacin, are contrain­ 6” Tongue Depressors Sterile by vaginal inflammation, high levels of proinflammatory dicated in pregnant women. Levofloxacin has improved efficacy 1000/case - $32.95 cytokine production, recruitment of leukocytes, and against Streptococci compared to ciprofloxacin. T= Transitional. the generation of toxic leukocytes and parabasal cells. Continued.............pg 2 866.889.WWMP(9967) • FAX: 609.570.1110 • WWW.WWMPONLINE.COM For information on placing a classified advertisement, please email [email protected]. Aerobic Vaginitis Continued From.............pg 1 The patient may present with all or some of these signs and symptoms scoring method used for bacterial vaginosis determination, which is based of AV: yellowish discharge, itching or burning sensation, dyspareunia, on a Gram-stained microscopic evaluation that enumerates specific bacterial absence of the fishy odor (negative amine test) typically associated with morphotypes. The presence and number of the different bacterial morphotypes, OURNAL ATCH BV, inflammation Figure( 1), toxic leukocyte infiltration, and the presence such as healthy Gram-positive Lactobacilli and anaerobic BV associated Gram- Donders GGG, Bellen G, JRezeberga D. 2011. cervical W mucus, cervical ectopy, or three or more of parabasal cells and naked rounded vaginal epithelial cells (Figure 2). negative and Gram-variable rods, contribute to the overall Nugent Score. A Aerobic Vaginitis in pregnancy. BJOG.118:1163– episodes of abnormal vaginal flora (AVF) in the Nugent score of 0 to 3 indicates normal flora, 4 to 6 intermediate flora, and 7 to 10 bacterial vaginosis. 1170. previous year before enrollment. Endocervical CT The determination of AV is also established by an ‘AV’ score. The score testing was performed by PCR. Vaginal swabs were is calculated with the use of high-power field microscopy to evaluate the Aerobic vaginitis (AV) is an alteration in vaginal collected for microscopic assessment of the microbial presence or absence of healthy Lactobacilli, number of leukocytes, number of flora pattern. Gram-stained smears were classified in toxic leukocytes, type of vaginal flora, and parabasal epithelial cells Table( 2). bacterial flora that differs from bacterial vaginosis (BV). Here, the presence of the healthy Gram-positive Lactobacilli is compared to AV is characterized by an abnormal vaginal microflora normal, intermediate or bacterial vaginosis (BV), and the presence of aerobic or facultative anaerobic Gram-positive cocci (such as recognition of Candida sp. morphotypes. Wet mount Streptococci, Staphylococci, or Enterococci) and Gram-negative bacilli (E. coli accompanied by an increased localized inflammatory and Klebsiella species). reaction and immune response, as opposed to the smears were used for detection of Trichomonas vaginalis and aerobic vaginitis (AV). Table 2. Criteria for the microscopic diagnosis of Aerobic Vaginitis (AV) suppressed immune
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