Vaginal Infections During Pregnancy: What You Need to Know

Pregnancy is a form of extreme weather — let’s call it a hurricane — that your home (vagina) may or may not be equipped to withstand.

During pregnancy, you expect your body to go through many obvious changes, such as larger breasts and a growing abdomen. What you may not know is your vagina goes through changes, too. It’s important to understand how pregnancy affects vaginal health, even after you give birth.

Your body transforms in many ways when you are pregnant, and an increase in vaginal discharge just happens to be one of those (not-so-fun) changes.

If the discharge is clear or white and odor-free, it's most likely caused by pregnancy hormones, and it's a sign that the vagina is healthy.

But sometimes, excess discharge signals an infection, which occurs when the natural balance of bacteria that lives in the vagina is disrupted. In fact, mild vaginal infections are actually quite common during pregnancy. Hormonal changes during this time can overwhelm the reproductive system. Often, vaginal infections are a result of these drastic changes.

Your vagina on pregnancy

The vagina is filled with good bacteria, just like your gut. But, unlike your gut, the composition is a little different.

The bacteria in your vagina are mostly lactobacilli, which produce lactic acid, among other things, that maintain an ideal pH level — typically 3.8 to 4.5 on a 14-point scale, which is considered mildly acidic.

This mild acidity is natural and self-cleaning — it keeps bad fungus (yeast), bacteria and parasites from colonizing, i.e. from causing an infection. When something happens to these bacteria, the pH levels in your vagina change. And pregnancy is a big something.

The precise mechanism has not been yet fully understood, but what doctors know is that the hormonal changes that accompany pregnancy can affect the good bacteria, and thus the pH levels of the vagina.

You can think of your vagina as a home, your good bacteria as you, and the hormones as weather: Pregnancy is a form of extreme weather — let’s call it a hurricane — that your home (vagina) may or may not be equipped to withstand, which can really affect how healthy and alive you (your bacteria) keep.

The good news is that when vaginal infections are diagnosed promptly, they're generally easy for doctors to treat. The tricky part is differentiating between normal discharge and discharge that signals an actual infection.

Here, we break down the causes of each infection, the symptoms, the treatments, and preventative tips.

Yeast Infection

During pregnancy, vaginal secretions contain more sugar, yeast’s meal of choice. A yeast infection will not harm your unborn baby, but it’ll make your life uncomfortable.

Yeast infections are more common in the second trimester. They may be caused by hormonal changes, taking medication like steroids or antibiotics, excessive douching, diabetes or a sexually transmitted disease.

The signs that you have a yeast infection are white or brown cottage-cheese-like vaginal discharge that smells like yeast, redness and irritation in the vulva and labia, and burning pain while having sex or urinating.

Yeast infections are diagnosed by a doctor’s vaginal exam or by examining a vaginal swab under a microscope to confirm the presence of yeast. They are usually treated with anti-fungal creams that have to be applied in the affected area.

Yeast infections can be prevented by wearing breathable underwear, keeping the vaginal area dry, wiping from front to back after urinating, limiting sugar intake and including yogurt in your diet.

Bacterial vaginosis

Bacterial vaginosis during pregnancy is very common. Around 10% to 40% of pregnant women reportedly get infected with bacterial vaginosis (BV). It is caused by harmful bacteria multiplying in the vagina, resulting in unpleasant symptoms.

Some of the women with BV may not show any signs of the infection. The symptoms of BV are burning sensation while urinating, fishy odor from the vagina, irritation and itching around the vaginal area, and abnormal, smelly vaginal discharge. The vaginal discharge may be white or grey and of a thin, watery consistency.

BV can be diagnosed by doing a pelvic exam and a vaginal culture. A course of antibiotics, usually Metronidazole or Clindamycin, generally does the trick.

Bacterial vaginosis can be treated with antibiotics that are safe for pregnant women. If symptoms persist, your doctor will prescribe antibiotics but only once you cross into the second trimester.

Safe sex practices and good hygiene can prevent BV to some degree. Refraining from douching, wearing cotton underwear, and keeping the vagina clean and dry helps in minimizing the risk of getting infected with BV.

If left untreated, BV can cause problems like preterm delivery, low birth weight in the baby, increased risk of catching other sexually transmitted infections (STIs), and pelvic inflammatory disease.

Trichomoniasis

Trichomoniasis is the most common and curable sexually transmitted disease in the United States caused by an organism called trichomonas vaginalis.

About 70% of people with trichomoniasis do not experience any symptoms, but they can still pass on the infection. In pregnant women, the infection can cause early labor and result in a baby with a low birthweight.

Trichomoniasis during pregnancy is caused by a parasitic protozoan microbe called Trichomonas vaginalis. It is usually sexually transmitted from an infected partner during intercourse. However, research has shown that it can be transmitted by sharing toilet seats or towels and even through swimming pools.

Symptoms of trichomoniasis include a foul-smelling, yellow-green discharge, vaginal itching and redness, and pain during urination and sex. The discharge may also be clear or white with a fishy odor.

Trichomoniasis is treated with antibiotics that are not harmful to the unborn baby. Trichomoniasis is a sexually-transmitted disease, so prevention is key. Get tested to make sure neither you nor your partner has it and passes it back to the other; use condoms; and stick to one sexual partner.

Always use condoms and keep your genital area clean and as dry as possible. Avoid public toilets and swimming pools during pregnancy.

Group B Streptococcus

According to gynecologists, 20 – 25 % of all healthy women have GBS bacteria living in their system: usually in the intestinal tract, rectum, or vagina. Most women with Group B Streptococcus (GBS) do not show any symptoms. Your doctor will automatically test you for GBS between weeks 35 and 37 of your pregnancy.

Because many healthy people have GBS living in their bodies, it's unclear why some individuals develop more serious infections from GBS, while others do not.
Group B Streptococcus during pregnancy is a bacterial infection that can cause complications like endometrial inflammation, urinary bladder infection, premature birth, and even stillbirth.

GBS may cause a urinary tract infection (UTI) in some people, but others have no symptoms at all. Symptoms of a UTI include pain or burning during urination, cloudy urine, and a sudden urge to urinate.

If you go into labor earlier than 37 weeks, if your water breaks more than 18 hours prior to childbirth, if GBS bacteria are found in your urine, if you have had a baby infected with GBS previously, or if you have a fever while in labor, you will be treated for GBS during delivery.

GBS is treated with antibiotics during delivery, so that you do not pass the infection to your baby. Usually, the antibiotic is given through an intravenous drip. It is not possible to prevent GBS, as the streptococcal bacteria are commonly present in our bodies.

As you can see, several of the common vaginal infections during pregnancy have similar symptoms. Check with your doctor, so that you can be diagnosed accurately and treated right away. Early detection and treatment ensure that you and your unborn baby are safe.

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