VAGINAL INFECTION

DEFINITION
Vaginal infections and vaginitis, or inflammation of the vaginadue to an imbalance of yeast
and bacteria normally found in the vagina, are very common during pregnancy .

In US women of childbearing age, bacterial vaginosis is the most common vaginal infection.
An estimated 7.4 million new cases of bacterial vaginosis occur each year which is as many
as 16%

A study has show that data collected from various studies showed the highest
prevalence of vaginal infection during pregnancy, mostly in Asian and African
countries (Disha & Haque, 2022).
Pathophysiology
Pregnancy causes increased levels of progesterone and estrogen. Progesterone suppresses the
ability of neutrophils to combat Candida, and estrogen disrupts the integrity of vaginal
epithelial cells against such pathogens as Candida and decreases immunoglobulins in
vaginal secretions. These issues, which continue throughout pregnancy, lend themselves to
multiple recurrences of infection.
Type of vaginal infection
1. Yeast infection
❏ This infection commonly occurs in pregnancy due to higher estrogen levels and glycogen
content in vaginal secretions
❏ Caused by one type of fungus called —-- candida
❏ Normally, candida live harmlessly in the body in a small amount include vagina. But
under certain situation, candida can overgrowth causing a vaginal infection.
❏ tend to occur during pregnancy because of changes in the immune system, increased production
of glycogen, and higher estrogen levels.
❏ Symptoms may include thick, white discharge (cottage cheese), vaginal itching, redness
of the vulva and vagina.
2. Chlamydia
❏ is the most common sexually transmitted infection (STI) in women, usually in those
ages 18 to 35 who have multiple sex partners.
Type of vaginal infection
.. Bacterial vaginosis.
3

❏ an imbalance of the normal vaginal flora with an overgrowth of anaerobic bacteria, is

the most commonly diagnosed vaginal infection
❏ A condition that happen because bacteria called lactobacili.
❏ a result of an imbalance of “good” and “harmful” bacteria in a vagina.
❏ Symptoms may include thick or whitish discharge, strong fishy odour may be noticeable,
burning when urinating.
4. . Group B streptococcus (GBS)
❏ most common cause of life-threatening infections in the newborn and possibly the
mother
❏ women who have GBS in their bodies when they give birth may pass it to their babies.
❏ intrapartum antibiotic prophylaxis are the key prevention strategies for GBS
❏ (IV antibiotics) can significantly reduce the risk of a GBS infection passing to the baby.
Sign and symptoms
● Itching and irritation in the vagina and vulva
● A burning sensation, especially during intercourse or while urinating
● Redness and swelling of the vulva
● Vaginal pain and soreness
● Vaginal rash
● Thick, white, odor-free vaginal discharge with a cottage cheese appearance
● Watery vaginal discharge
Causes
A normal, healthy vagina contains bacteria and sometimes yeast without
necessarily having an infection. But certain things can change the environment in
the vagina, enabling bacterial or yeast overgrowth and causing symptoms. These
include:

● Douching, or rinsing the vagina with water or other liquid

● Female hormone level changes
● Taking antibiotics
● Vaginal intercourse
Complication
Infections can affect a developing baby in one of three ways:

● They may harm the mother, making her body less able to nurture the baby or
requiring the use of drugs that may harm a fetus.
● They can directly harm the baby by causing changes that lead to birth
abnormalities.
● They can trigger premature labor or a miscarriage.
Investigation
High vaginal swab
❏ used to obtain a sample of discharge from the vagina.
❏ This is then sent to a laboratory for investigation.
❏ A high vaginal swab is used to diagnose vaginal infections including bacterial
vaginosis and trichomonas vaginalis.
Prevention
❏ Practice good hygiene
❏ Wear looser and breathable clothing. Recommending the use of cotton underwear helps
wick away moisture that may otherwise encourage vaginal organism growth
❏ Avoid douching - Douching can remove normal bacteria in your vagina that can help protect
you from infection.
❏ Keep the area around the vagina clean and dry
❏ Maintain proper diet, sleep and exercise.
❏ Use warm water only and no soap to clean the outside of your vagina. Always wipe front to
back
❏ Use plain warm water to clean the vulva. Soaps and detergents can change the normal
balance of organisms inside the vagina.
❏ Attend health teaching talk in MCH if there is any.
 Midwifery care and management.
Provide information about the possible effects of the women will be aware and keep her updated on
infection to the women and fetus her situation.

Obtain appropriate specimens and monitor vaginal infection can be diagnosed by taking a
laboratory/ diagnostic studies as indicated. sample of the discharge from the vaginal wall.

Identify the source, location and extent of To note sign and symptoms of an infectious
discomfort of women for eg the itching process.

administer antibiotics and other medication as for treatments and alleviate the symptoms of
prescribed infection.

emphasize the importance about hygienic using cotton underwear to avoid irritating the
measures such as frequent bathing, use of cotton perineal area and to prevent further infection.
underwear

Review hygiene measures, including wiping vulva helps prevent rectal E. coli contaminants from
from front to back after urinating and washing reaching the vagina and reduces contamination
hands frequently. with other viruses or bacteria that may be
transmitted by poor hygiene practices
 Midwifery care and management.
advice women increase fluid intake (drink a lot of
water)
Educate the women and her partner about the risk
of transmission and the risk of damage to the fetus
Encourage the women to express their feelings
and concerns
Provide an open environment for the women to
discuss concerns about sexuality.
For hydration and to flush down the bacteria
When infection is suspected in a pregnant women
it is essential to engage the partner in decision
making. Women and her partner must be provided
with basic information on the risk of infection
transmission to the fetus
Providing the women an opportunity to express
their feelings allows them to feel more in control of
the situation. Verbalization can decrease anxiety
and depression and facilitate positive coping
behaviors
This promotes sharing beliefs and values about
sensitive subjects and identifies misconceptions or
myths that may interfere with adjustment to the
situation.