Aims: Aerobic vaginitis (AV) is a newly defined clinical entity which may interfere with women's reproductive health and have negative effects on pregnancy. This study was to identify the risk factors for AV. Methods: Participants in this case-control study included healthy women and women with AV. All participants completed a standardized questionnaire covering sociodemographic factors, sexual behaviors, personal hygiene habits and health behaviors. Uni- and multivariate logistic regression analyses were used for statistical evaluation. Results: A total of 290 women of reproductive age were enrolled. In the multivariate analysis, unmarried status (odds ratio [OR] 2.606, 95% confidence interval [CI] 1.257-5.402), use of an intrauterine device (OR 4.989, 95% CI 1.922-12.952), long-term use of antibiotics (OR 11.176, 95% CI 1.363-91.666) and frequent vaginal douching (OR 4.689, 95% CI 1.363-16.135) were independent risk factors for AV. On the contrary, consistent condom use (OR 0.546, 95% CI 0.301-0.991) and college-level education or above (OR 0.255, 95% CI 0.131-0.497) were independent protective factors. Conclusion: Measures that may be considered to prevent AV include enhancing education to improve women's knowledge related to reproductive health, especially unmarried women, encouraging them to consistently use condoms as a contraceptive method, to avoid long-term use of antibiotics and to stop frequent vaginal douching.

Keywords:
Aerobic vaginitis, Abnormal vaginal flora, Risk factors, Intrauterine device, Vaginal douching
1.
Donders GG, Vereecken A, Bosmans E, Dekeersmaecker A, Salembier G, Spitz B: Definition of a type of abnormal vaginal flora that is distinct from bacterial vaginosis: aerobic vaginitis. BJOG 2002;109:34-43.
2.
Tansarli GS, Kostaras EK, Athanasiou S, Falagas ME: Prevalence and treatment of aerobic vaginitis among non-pregnant women: evaluation of the evidence for an underestimated clinical entity. Eur J Clin Microbiol Infect Dis 2013;32:977-984.
3.
Fan A, Yue Y, Geng N, Zhang H, Wang Y, Xue F: Aerobic vaginitis and mixed infections: comparison of clinical and laboratory findings. Arch Gynecol Obstet 2013;287:329-335.
4.
Donders G, De Wet HG, Hooft P, Desmyter J: Lactobacilli in Papanicolaou smears, genital infections, and pregnancy. Am J Perinatol 1993;10:358-361.
5.
Marconi C, Donders GG, Martin LF, Ramos BR, Duarte MT, Parada CM, Tristao AR, Silva MG: Chlamydial infection in a high risk population: association with vaginal flora patterns. Arch Gynecol Obstet 2012;285:1013-1018.
6.
Donders G, Bellen G, Rezeberga D: Aerobic vaginitis in pregnancy. BJOG 2011;118:1163-1170.
7.
Donati L, Di Vico A, Nucci M, Quagliozzi L, Spagnuolo T, Labianca A, Bracaglia M, Ianniello F, Caruso A, Paradisi G: Vaginal microbial flora and outcome of pregnancy. Arch Gynecol Obstet 2010;281:589-600.
8.
MacPhee RA, Miller WL, Gloor GB, McCormick JK, Hammond JA, Burton JP, Reid G: Influence of the vaginal microbiota on toxic shock syndrome toxin 1 production by Staphylococcus aureus. Appl Environ Microbiol 2013;79:1835-1842.
9.
Jahic M, Mulavdic M, Hadzimehmedovic A, Jahic E: Association between aerobic vaginitis, bacterial vaginosis and squamous intraepithelial lesion of low grade. Med Arch 2013;67:94-96.
10.
Sobel JD: Desquamative inflammatory vaginitis: a new subgroup of purulent vaginitis responsive to topical 2% clindamycin therapy. Am J Obstet Gynecol 1994;171:1215-1220.
11.
Peacocke M, Djurkinak E, Thys-Jacobs S: Treatment of desquamative inflammatory vaginitis with vitamin D: a case report. Cutis 2008;81:75-78.
12.
Peacocke M, Djurkinak E, Tsou HC, Thys-Jacobs S: Desquamative inflammatory vaginitis as a manifestation of vitamin D deficiency associated with Crohn disease: case reports and review of the literature. Cutis 2010;86:39-46.
13.
Edwards L, Friedrich EJ: Desquamative vaginitis: lichen planus in disguise. Obstet Gynecol 1988;71:832-836.
14.
Nugent RP, Krohn MA, Hillier SL: Reliability of diagnosing bacterial vaginosis is improved by a standardized method of Gram stain interpretation. J Clin Microbiol 1991;29:297-301.
15.
Larsen B, Monif GR: Understanding the bacterial flora of the female genital tract. Clin Infect Dis 2001;32:e69-e77.
16.
Boris S, Suarez JE, Vazquez F, Barbes C: Adherence of human vaginal lactobacilli to vaginal epithelial cells and interaction with uropathogens. Infect Immun 1998;66:1985-1989.
17.
Reid G, Bruce AW, McGroarty JA, Cheng KJ, Costerton JW: Is there a role for lactobacilli in prevention of urogenital and intestinal infections? Clin Microbiol Rev 1990;3:335-344.
18.
O'Hanlon DE, Lanier BR, Moench TR, Cone RA: Cervicovaginal fluid and semen block the microbicidal activity of hydrogen peroxide produced by vaginal lactobacilli. BMC Infect Dis 2010;10:120.
19.
Ma L, Lv Z, Su J, Wang J, Yan D, Wei J, Pei S: Consistent condom use increases the colonization of Lactobacillus crispatus in the vagina. PLoS One 2013;8:e70716.
20.
Yan H, Chen W, Wu H, Bi Y, Zhang M, Li S, Braun KL: Multiple sex partner behavior in female undergraduate students in China: a multi-campus survey. BMC Public Health 2009;9:305.
21.
Santhya KG, Acharya R, Jejeebhoy SJ: Condom use before marriage and its correlates: evidence from India. Int Perspect Sex Reprod Health 2011;37:170-180.
22.
Peddie BA, Bishop V, Bailey RR, McGill H: Relationship between contraceptive method and vaginal flora. Aust N Z J Obstet Gynaecol 1984;24:217-218.
23.
Ocak S, Cetin M, Hakverdi S, Dolapcioglu K, Gungoren A, Hakverdi AU: Effects of intrauterine device and oral contraceptive on vaginal flora and epithelium. Saudi Med J 2007;28:727-731.
24.
Jacobson JC, Turok DK, Dermish AI, Nygaard IE, Settles ML: Vaginal microbiome changes with levonorgestrel intrauterine system placement. Contraception 2014;90:130-135.
25.
Lee NC, Rubin GL, Ory HW, Burkman RT: Type of intrauterine device and the risk of pelvic inflammatory disease. Obstet Gynecol 1983;62:1-6.
26.
Sjöberg I, Grahn E, Håkansson S, Holm SE: Influence of phenoxymethylpenicillin on the vaginal ecosystem. Gynecol Obstet Invest 1992;33:42-46.
27.
Onderdonk AB, Delaney ML, Hinkson PL, DuBois AM: Quantitative and qualitative effects of douche preparations on vaginal microflora. Obstet Gynecol 1992;80:333-338.
28.
Pavlova SI, Tao L: In vitro inhibition of commercial douche products against vaginal microflora. Infect Dis Obstet Gynecol 2000;8:99-104.
29.
Marconi C, Donders GG, Bellen G, Brown DR, Parada CM, Silva MG: Sialidase activity in aerobic vaginitis is equal to levels during bacterial vaginosis. Eur J Obstet Gynecol Reprod Biol 2013;167:205-209.
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2015
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