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Vaginal dysbiosis, such as bacterial vaginosis (BV) and aerobic vaginitis (AV), is an important cause of premature birth in pregnant women. However, there is very little research on vaginal microbial distribution in AV compared to that in BV. This study aimed to analyze the composition of the vaginal microbiota of pregnant women with AV using microbial community analysis and identify the causative organism using each criterion of the AV scoring system. Also, we compared the quantification of aerobic bacteria using quantitative polymerase chain reaction (qPCR) and their relative abundances (RA) using metagenomics. This prospective case–control study included 228 pregnant Korean women from our previous study. A wet mount test was conducted on 159 women to diagnose AV using the AV scoring system. Vaginal samples were analyzed using metagenomics, Gram staining for Nugent score determination, conventional culture, and qPCR for  Staphylococcus  spp. , Streptococcus  spp., and  Enterobacteriaceae . The relative abundances (RAs) of eleven species showed significant differences among the three groups (Normal flora (NF), mild AV, and moderate AV). Three species including  Lactobacillus crispatus  were significantly lower in the AV groups than in the NF group, while eight species were higher in the AV groups, particularly moderate AV. The decrease in the RA of  L. crispatus  was common in three criteria of the AV scoring system ( Lactobacillary , WBC, and background flora grades), while it did not show a significant difference among the three grade groups of the toxic leukocyte criterion. Also, the RAs of anaerobes, such as  Gardnerella  and  Megasphaera , were higher in the AV groups, particularly moderate AV, while the RAs of aerobes were very low (RA < 0.01). Therefore, qPCR was performed for aerobes ( Staphylococcus  spp. , Streptococcus  spp., and  Enterobacteriaceae ); however, their quantification did not show a higher level in the AV groups when compared to that in the NF group. Therefore, AV might be affected by the RA of  Lactobacillus  spp. and the main anaerobes, such as  Gardnerella  spp. Activation of leukocytes under specific conditions might convert them to toxic leukocytes, despite high levels of  L. crispatus . Thus, the pathogenesis of AV can be evaluated under such conditions.

Composition of Vaginal Microbiota in Pregnant Women With Aerobic Vaginitis