From a lab test, how can I tell if my case is normal, BV, CV, AV or yeast?

Today, many microbiology labs offer vaginal microbiome testing with the cutting-edge NGS (next generation sequencing) technology.

The following labs offer a vaginal microbiome test.

The NGS technology uses a computerized robotic system to test your vaginal sample. It is dumb proof and provides complete information on the population of microorganisms inside your vagina.

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Then, how can I tell if my case is normal or abnormal? When the vaginal microbiome is balanced, it is normal. When it is imbalanced, it is abnormal or called dysbiosis. Conditions that may cause dysbiosis include BV (bacterial vaginosis), AV (aerobic vaginitis), CV (cytolytic vaginosis) and yeast (vaginal candidiasis).

  • Normal. If your lab test report shows predominantly protective Lactobacillus bacteria (90-98%) and you do not have any discomfort symptoms, you are normal.
  • BV. BV is an imbalance of the vaginal microbiome, not a true infection or inflammation. Thus, its name is bacterial vaginosis, not vaginitis. If your lab test shows predominantly anaerobic bacteria (>80%) and low (<20%) or no protective Lactobacillus and you have discomfort symptoms like fishy odor, discharge, itching, and/or irritation, you may have BV. Anaerobic bacteria commonly associated with BV include Gardnerella vaginalis, Prevotella species, Mobiluncus species, Atopobium vaginae, and other BV-associated bacteria. The recommended starting treatment is [BV Clear]( (age <45), [NeuEve Gold]( (age 46-51), [Silver]( (age 51-56), or [Silk]( (age 56 - 70). [Sensitive Silk]( (age >70). After one month of treatment, if your BV is not cleared, you may move up a phase. The strengths of these formulas from mild to strong are: Sensitive Silk ->Silk ->Silver ->Gold -> BV Clear->BV Finisher.
  • AV. AV is a true infection or inflammation. Thus, its name is aerobic vaginitis. The suffix "-itis" means inflammation. Thus, even if the lab test shows that the aerobic bacteria are less than 50%, or as little as 1%, and if you have painful inflammation symptoms, you may have AV. A key difference between BV and AV is that BV may have odor, itching, and irritation but rarely has pain because BV is not a true inflammation. AV is a true inflammation and is almost always associated with pain. Aerobic bacteria need oxygen to grow. The most common bacteria associated with AV include E. coli, Staphylococcus aureus, group B Streptococcus (GBS), Enterococcus faecalis and Klebsiella pneumoniae. The recommended treatment is AV NIL.
  • CV. If your lab test report shows nearly 100% (often over 98%) Lactobacillus bacteria and low or no other bacteria and you have CV-related discomfort symptoms like discharge, pain, and/or irritation, you may have CV. The pain is not caused by inflammation. It is caused by acid burns, like occasional stomach acid regurgitation into the mouth. You can differentiate by taking a vaginal pH. If your pH is below 4.5, your burning symptoms are more severe before your period, but less severe after your period, and/or you find some relief after a baking soda sitz bath, you may have CV. The recommended treatment is CV Ease.
  • Yeast. The most common cause of vaginal yeast infection is Candida albicans. There are also other Candida species. If Candida is not detected, you do not have yeast infection. However, if Candida is detected and at a high level, it indicates that you have yeast infection. You can manage it easily with an over-the-counter antifungal drug like Monistat-3. You can find it in your local drugstore. However, if your yeast keeps coming back, you may have yeast in the gut. This is common if you have used antibiotics for a long term. You can reduce yeast in the gut by taking a dietary supplement like Reset & Rejoice.
  • Exception: Lactobacillus iners, the Outlier in the Lactobacillus Genus
    • Lactobacillus iners stands out as a unique member of the Lactobacillus genus, differing significantly from its protective counterparts. This species releases a cytolytic toxin known as inerolysin, which sets it apart from other Lactobacillus species.
    • When present at low levels (1-50%), L. iners may interact with AV-related bacteria like Enterococcus (AV), contributing to AV-related symptoms such as pain and irritation. In this scenario, L. iners acts as an exacerbating factor, intensifying the discomfort associated with AV.
    • Similarly, at these low levels, L. iners can collaborate with BV-related bacteria like Gardnerella (BV). This association can lead to BV-related symptoms, such as odor and discharge, further worsening BV-related discomforts. In cases where BV is primarily driven by L. iners, standard BV care products may not offer effective relief.
    • When L. iners becomes dominant (over 50%), either on its own or in combination with other Lactobacillus species (total Lactobacillus exceeding 98%), symptoms resembling CV, such as discharge, pain, and/or irritation, may occur. However, using CV Ease products might not provide relief in these cases, as the damage might be attributed to the acid and toxin produced by L. iners.

For treatment of L. iners-related infections, you must consider if you have any discomfort symptoms. if you have symptoms like odor, discharges, and/or irritation, the recommended treatment is AV NIL. To date, the only product that has successfully cleared L. iners is AV NIL.

What if My Test Shows Both Aerobic and Anaerobic Bacteria? What Should I Do?

Anaerobic bacteria are akin to fish, thriving only in water-like environments, while aerobic bacteria need air for growth, similar to land animals. However, some bacteria, like ducks that can swim and live on land, can coexist in both environments. Therefore, it's possible for some anaerobic and aerobic bacteria to coexist.

When your lab test indicates the presence of both aerobic and anaerobic bacteria, it suggests that you might be experiencing both aerobic vaginitis (AV) and bacterial vaginosis (BV). The symptoms you're experiencing can help determine which condition is more prevalent.

If you're experiencing a strong fishy odor and discharge, but little to no pain or irritation, BV might be the dominant issue. In this case, it would be advisable to treat BV first.

Conversely, if there's minimal or no odor, but you have pain or irritation, AV might be predominant. You should consider treating AV first in this scenario.

In situations where you have both a fishy odor and pain, it's possible that you're dealing with severe cases of both BV and AV. Treating AV first could be beneficial, as AV treatment might help alleviate both conditions, whereas BV treatment alone may not effectively address AV.

If your test results show low levels of Lactobacillus species and high levels of destructive bacteria but you're not experiencing any symptoms, taking probiotic supplements could help in promoting overall vaginal wellness.

To understand vaginal dysbiosis, you may find this article helpful:

**Disclaimer: This article is for information purposes only. It is about natural products, nutrients, and/or methods for managing discomforts associated with vaginal dysbiosis (not a true infection or disease). It is not medical advice for the treatment of any disease.

Jan 25, 2024

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