Obstetric Infections During Pregnancy: Common Vaginal Conditions and Their Risks

Genital Infections During Pregnancy: Diagnosis, Treatment and Potential Risks

Op. Dr. Deniz Gökalp — OB/GYN and IVF Specialist

During pregnancy, certain microorganisms in the maternal genital flora may affect both maternal health and fetal development. Not all infections pose the same risk; while some are harmless, others may lead to complications like preterm birth, premature rupture of membranes, or neonatal infections.

This article covers five common vaginal infections frequently asked about during pregnancy: Candida, Gardnerella, Group B Streptococcus (GBS), HPV, and Herpes Simplex Virus (HSV).

Candida Vaginitis (Yeast Infection)

Why is it common in pregnancy?
Increased estrogen and glycogen levels during pregnancy make the vaginal environment more favorable for yeast growth. Candida vaginitis is seen in approximately 20–30% of pregnant women.

Symptoms:

• Intense itching

• Thick, white “cottage cheese-like” discharge

• Burning sensation

• Pain during intercourse

Diagnosis:

• Vaginal examination + microscopy

• Vaginal culture if needed

Treatment:

• Topical (vaginal) antifungals are first-line in pregnancy.

• Terconazole, clotrimazole, and miconazole are considered safe.

• Oral fluconazole is not routinely recommended, especially in the first trimester.

Pregnancy risks:
Candida infections do not increase the risk of preterm birth or birth defects. They primarily affect maternal comfort. Rarely, they can be passed to the newborn during delivery, causing oral thrush (candidiasis).

Gardnerella Vaginalis / Bacterial Vaginosis (BV)

Why is it important during pregnancy?
BV results from an imbalance in the vaginal flora and may impact pregnancy outcomes, especially in symptomatic cases.

Symptoms:

• Thin, grey-white discharge with a fishy odor

• Odor may worsen after intercourse

• Itching is rare

Diagnosis:

• Amsel criteria or vaginal pH testing

• Presence of “clue cells” under microscope

Treatment:
Metronidazole or clindamycin can be safely used during pregnancy.
Symptomatic BV must be treated during pregnancy.

Pregnancy risks:

• Preterm birth

• Premature rupture of membranes

• Increased risk of postpartum uterine infections

BV is particularly important in patients with a history of miscarriage or early labor.

Group B Streptococcus (GBS)

What is it and is its presence normal?
GBS is found harmlessly in the vagina and rectum of about 10–30% of women. It is not a natural part of the vaginal flora, but colonization is common.

Screening:
All pregnant women are screened at 36–37 weeks of gestation via vaginal-rectal swab.

Why is it important?
GBS can pass to the baby during birth, causing:

• Neonatal sepsis

• Pneumonia

• Meningitis

For GBS-positive patients, antibiotic prophylaxis during labor is essential.

Treatment:

• No treatment is required during pregnancy.

• IV penicillin or ampicillin is administered once labor starts or if the water breaks.

Pregnancy risks:
GBS rarely affects the mother but can cause serious infection in the newborn if untreated during delivery.

HPV (Human Papillomavirus)

Is HPV common in pregnancy?
Yes. Due to immune system changes, genital warts may grow or increase during pregnancy.

Diagnosis:

• Pap smear / HPV DNA test

• Colposcopy if needed

Treatment:
Safe methods during pregnancy include:

• Cryotherapy

• Topical TCA (trichloroacetic acid)
  Note: Imiquimod and similar agents are not recommended during pregnancy.

Can HPV be transmitted to the baby?
Rarely, the virus may pass during birth and cause laryngeal papillomatosis. However, this is very uncommon and C-section is not routinely recommended for HPV alone.

Pregnancy risks:

• Enlargement of genital warts

• Cervical smear abnormalities usually remain stable and can be followed after delivery.

HSV (Herpes Simplex Virus) – Genital Herpes

Why is it important in pregnancy?
HSV is particularly dangerous when a primary infection occurs near delivery, increasing the risk of neonatal transmission.

Symptoms:

• Painful blisters

• Burning or stinging sensation

• Painful urination

Diagnosis:

• Clinical exam

• PCR testing

Treatment:

• Acyclovir and valacyclovir are considered safe during pregnancy.

• Suppressive therapy is recommended from week 36 onward in women with prior HSV outbreaks.

Pregnancy risks:

• Primary infection → higher miscarriage risk, preterm labor

• Active lesions at delivery → risk of neonatal herpes (sepsis, meningitis)
  C-section is recommended if active lesions are present at labor.

Tips to Prevent Vaginal Infections During Pregnancy

• Use of probiotics to support healthy flora

• Wear cotton underwear

• Avoid staying in wet swimsuits for long

• Refrain from unnecessary vaginal douching

• Avoid unprescribed antibiotics

• Use condoms for STI prevention

With accurate diagnosis and proper treatment, most vaginal infections in pregnancy can be effectively managed. The key is to identify which infections pose a real risk, conduct timely screenings, and start treatment when necessary.

Disclaimer:
This article is for educational purposes only. Every patient’s condition should be evaluated individually by a healthcare professional.