Common Vaginal Infections in Pregnancy: Symptoms & Treatment

Key takeaways:

• Vaginal infections are common during pregnancy due to hormonal changes and a weakened immune system.
• Common vaginal infections during pregnancy include yeast infection, bacterial vaginosis, trichomoniasis, Group B streptococcal, and urinary tract infections.
• Early detection and treatment of infection are crucial to prevent complications for the mother and child.
• Maintaining good hygiene and regular prenatal check-ups can help minimize the risk of infection.

Pregnancy brings countless changes to the body. Among these changes are hormonal shifts and a temporarily weakened immune system, which increases the risk of vaginal infections.

Hormonal changes, particularly the increase in estrogen, a female reproductive hormone, alter the natural microbial balance of the vagina. Also, the mother’s immune system is slightly weakened to prevent it from seeing the baby as a foreign object and launching an attack or rejecting it.

These infections, while common, can cause premature birth, low birth weight, and newborn infection if left untreated. 

In this article, we will explore four common vaginal infections during pregnancy and the preventive measures to ensure a healthy pregnancy free from complications.

Some vaginal infections that commonly occur during pregnancy include the following. 

1. Yeast infection

Yeast infection, also known as candidiasis, is caused by the overgrowth of a microorganism called fungus. 

The most common fungus that causes yeast infections is Candida albicans, which accounts for 90% of yeast infection cases. Other fungi, like Candida glabrata, cause the remaining 10%. Yeast infection is one of the most common vaginal infections, affecting about 30% of pregnant women.

Untreated yeast infection during pregnancy can lead to:

• Early labour (birth before 37 weeks of pregnancy)
• Low birth weight (baby’s weight less than 2.5kg or 5.5 pounds)
• Delivery of a dead baby after 22 weeks of pregnancy)
• The breaking of the protective water around the baby before labor
• Infection in the placenta or uterus
• Death of a newborn within the first 28 days of life.

Symptoms of yeast infection

Symptoms of yeast infection include:

• Intense irritation and itching in the vaginal area
• Thick, whitish vaginal discharge that looks like cottage cheese
• Redness and swelling of the vulva
• Painful urination 
• Pain during sex

Treatments for yeast infection

Doctors commonly treat yeast infection during pregnancy by prescribing:

• Antifungal creams or suppositories: medications like miconazole, clotrimazole, and nystatin cream are safe to use in pregnancy.

Note: Avoid the use of oral antifungal medication e.g. fluconazole, as it can cause abortion, congenital heart disease, stillbirth, and newborn death.

2. Bacterial vaginosis (BV)

Bacterial vaginosus (BV) occurs when there is an imbalance of the good and harmful bacteria in the vagina. Harmful bacteria species, like Gardnerella vaginalis, overgrow the good bacteria called Lactobacillus. 

Bacterial vaginosis is one of the most common infections in pregnant women, as hormonal shifts reduce the quantity of Lactobacillus bacteria.

Bacterial vaginosis, when left untreated, can cause:

• Early delivery
• The breaking of the protective water around the baby before labor
• Abortion
• High risk of contracting other sexually transmitted infections like human immunodeficiency virus (HIV)
• Low birth weight
• Pelvic inflammatory diseases (Infection of one or more of the female reproductive organs)
• Increased risk of postpartum endometritis (infection of the lining of the womb)
• Increased risk of meningitis (inflammation of membranes surrounding the brain) in newborn

Symptoms of bacterial vaginosis

BV can cause symptoms like:

• Thin, greyish-white vaginal discharge with a strong fish smell.
• Vaginal itching and irritation.
• Burning sensation during urination

Treatments

Bacterial vaginosis is treated with antibiotics, which can come as pills to swallow or insert into the vagina.

According to the CDC guidelines, the following antibiotics are safe for use during pregnancy:

• Metronidazole
• Clindamycin

3. Trichomoniasis

Trichomoniasis is a sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis. The reduction in the beneficial Lactobacillus in pregnancy makes the vaginal environment less acidic. This allows trichomoniasis to not only survive but also thrive. 

If left untreated during pregnancy, trichomoniasis can lead to complications like:

• Early delivery
• Low birth weight 
• High risk of the mother contracting the human immunodeficiency virus (HIV)
• The breaking of the protective water around the baby before labor
• Transmission of T. vaginalis to the baby during birth

Symptoms of trichomoniasis

Symptoms of trichomoniasis include:

• Frothy, yellow-green vaginal discharge with a foul odour
• Vaginal itching and irritation
• Pain during urination and intercourse
• Abdominal pain

Treatment

Trichomoniasis is typically treated using antibiotics. Metronidazole is the standard treatment and is considered safe during pregnancy.

4. Group B streptococcus (GBS)

Group B streptococcus infection is caused by the bacteria Streptococcus agalactiae, found in the rectum and vagina of healthy women. While it is harmless to the mother, it can be passed to the baby during delivery, potentially causing severe complications like:

• Sepsis (body’s extreme defence response to infection)
• Meningitis (inflammation of the tissue covering the brain and the spinal cord)
• Pneumonia (infection of the lung)

According to the American College of Obstetricians and Gynecologists, Group B Streptococcus screening should be done at 36-37 weeks of pregnancy.

Symptoms of GBS

Most cases of GBS don't present with symptoms. But when symptoms are present, a person may experience vaginal discharge (rare) or urinary tract symptoms.

Treatment

Antibiotics are the typical treatment for GBS. For pregnant people with this infection, penicillin or ampicillin are administered intravenously during labor and delivery.

Why infections are common during pregnancy

The bacteria Lactobacillus dominates the human vagina environment. This beneficial bacteria helps prevent infection by making the vagina acidic to protect against infections. 

However, during pregnancy, the following occur:

1. Hormonal changes: An increase in estrogen levels alter the vaginal environment balance, making it prone to infections.
2. Weakened immune system: The immune system is slightly suppressed to protect the growing baby, reducing the body’s ability to fight infection.

Understanding these factors is the first step in preventing complications during pregnancy.

How to prevent vaginal infections during pregnancy

Preventing infections during pregnancy involves maintaining a healthy vaginal environment and practising good hygiene. Below are some tips to help you get started:

• Wear cotton breathable underwear to allow airflow and keep the vaginal area dry.
• Avoid tight underwear and pantyhose.
• Change your underwear twice daily.
• Avoid douching, using scented soaps and feminine washes to wash the vagina, or vagina sprays, which can disrupt the vaginal pH.
• Wipe from front to back after using the restroom to prevent bacteria from spreading.
• Eat diets rich in probiotics, like yoghurt, to support good bacteria.
• Stay hydrated and urinate frequently to flush out bacteria.
• Practice safe sex and limit sexual partners to reduce the risk of sexually transmitted infections (STIs).
• Wash your genital area gently with water.
•  Avoid over-washing or scrubbing your genital area.
• Remove wet workout clothes or swimsuits immediately after activities.

When to speak to a doctor

It’s important to consult your doctor immediately if you notice any symptoms of vaginal infections or discover that your sexual partner is infected.

Early diagnosis and treatment are crucial to prevent complications for the mother and baby.

Final notes

Vaginal infections during pregnancy are common but treatable. By recognizing symptoms early, seeking treatment, and practicing good hygiene, pregnant women can ensure a healthy pregnancy and safe delivery. Always seek medical advice if you suspect an infection to avoid complications.