If left untreated, bacterial vaginosis can be dangerous in pregnancy because it increases the risk of premature birth.
It happens to all women, in the course of life, to run into an infection or disorders of the genital apparatus. But what happens if it happens during pregnancy? And how much do these disorders affect the mother and baby?
“First of all, you need to know that there are bacteria allied to women’s health,” explains Alessandra Graziottin, director of the Center for Gynecology and Medical Sexology at the San Raffaele Resnati Hospital in Milan. “Problems occur if the balance is upset. An acrid and unpleasant genital odor is the symptom of the presence in excess of a germ, the Gardnerella vaginalis, detectable with an examination that, not surprisingly, is called “fish-test” or “sniff-test”».
A guest… undesired
“Gardnerella normally lives in the vagina, but it “makes itself felt” only when it grows excessively, since it usually constitutes a small minority among the populations of microorganisms that characterize the female genital apparatus. This situation of imbalance is called bacterial vaginosis, because it cannot be classified among infectious diseases in the strict sense, not being caused by germs coming from outside, but by a quantitative imbalance between those that the woman normally has» explains the gynecologist.
It is estimated that 5-15% of women of childbearing age face bacterial vaginosis, which can also occur during pregnancy. Another category at great risk are women suffering from a sexually transmitted disease.
In half of the cases the most characteristic symptom is whitish vaginal discharge, of unpleasant odor. Sometimes pain can also occur during sexual intercourse, while inflammatory symptoms such as irritation, itching and burning are almost always absent. The sniff-test highlights the bad smell of secretions, adding to these a drop of potassium hydroxide after placing them on a slide. The diagnosis can also be made with a vaginal swab, through microscopic examination, in search of bacteria related to vaginosis, and with the pap-test.
To have features in common with bacterial vaginosis is another genital disorder caused by a parasite, Trichomonas vaginalis. In this case, however, the secretions are greenish-yellow and there is not the typical smell of spoiled fish, but a musty smell, stale.
The causes of bacterial vaginosis
But what causes the abnormal growth of Gardnerella? There is no evidence of sexual transmission, although frequent intercourse can be a predisposing factor: male sperm raises the pH of the vagina, creating environmental conditions favorable to sperm, but also to some bacteria that are not normally found in the vaginal microflora of healthy women. As well as the use of vaginal douches seems to favor its development.
Furthermore, a clinical research of a few years ago showed that the risk of bacterial vaginosis increases by 50% with the increase of fats in the diet, while it is reduced by 60% with the increase of folate, vitamin E and calcium (probably due to an improvement of the nearby intestinal ecosystem).
“The certain cause is a variation in the acidity of the vagina, i.e. its pH which, in turn, is regulated by the level of estrogen present in the genital tissues, and therefore changes from childhood to the age of development, from fertile life to menopause,” explains Alessandra Graziottin.
From puberty onwards (when estrogens are set in motion) the vaginal ecosystem (also called microbiota or microbiome) undergoes a series of changes and becomes “populated” with microorganisms essential for the health of the genital organs. Most of them are “beneficial” germs, which belong to the group called Doderlein’s bacilli, composed of over 40 different strains.
Alessandra Graziottin continues: “They all produce lactic acid and hydrogen peroxide (H2O2), substances that help keep the vaginal pH low (around 4). They also produce bacteriocins and lactocins, which constitute an additional weapon of defense against germs, in particular those coming from the intestine (Escherichia coli, Enterococcus faecalis), which can cause vaginitis (ie a real inflammation from infection) and cystitis.
The importance of pH
An environment is acidic when the pH goes from 0 to 7 and basic if the pH goes from 7 to 14, and thus conditions the possibility of “life” of microorganisms.«If the vaginal pH rises from the normal value of 4 (for a healthy woman of childbearing age) to 5 or 6, Doderlein’s bacilli decrease and the Gardnerella (or Haemophilus) increases, which is normally there, but is few in number”, explains the gynecologist. “Growth causes a fermentation of vaginal substances, causing symptoms such as abundant vaginal secretions (80% of cases) with an unpleasant smell (of “spoiled fish”), sometimes with itching and vaginal and urinary burning”.
The measurement of pH is also important during pregnancy: “If the vaginal pH is below 4.5, it means that everything is going well. Conversely, an increase in pH is associated with a higher risk of miscarriage, premature birth and babies with low birth weight (below 2.5 kg). This is because, if it is not treated, the bacterial vaginosis associated with the proliferation of Gardnerella and the reduction of lactobacilli – which also protect against the risk of concomitant infections coming from the outside – can damage the amniotic membranes (amnionitis), causing them to rupture”, warns Alessandra Graziottin.
At the slightest suspicion, it is advisable to immediately contact your doctor or gynecologist for a therapy to be followed scrupulously, even if the symptoms disappear during treatment and before completing it. Medicines can consist of antibiotics and drugs that rebalance the vaginal ecosystem, used individually or in combination.
How to fight bacterial vaginosis in pregnancy
The therapeutic schemes for pregnant women with symptoms or without, but at risk of preterm birth – obviously under strict medical supervision – provide for the prescription of antibiotic therapy by mouth or in cream or eggs for local application, with different methods of dosage and administration also based on the trimester of gestation.
In general, the use of ecosystem rebalancers is the most suitable for healing in pregnancy: in addition to having fewer side effects and fewer problems than antibiotics, unlike the latter they promote the proliferation of lactobacilli, essential to avoid the risk of recurrence and ensure the success of pregnancy.
Antibiotic-based treatments, then, are not always decisive: “The abnormal presence of the microorganism is in fact a consequence of more important hormonal and biochemical changes,” Alessandra Graziottin points out. “We must try to change factors such as the level of the main female hormones (estrogen) and the pH that govern the health of the vaginal microbiome. When estrogenic levels are normal and the pH is 4, the proportions between the different microorganisms are self-regulating and remain in balance.
The best prevention of bacterial vaginosis is to bring the vaginal pH back to the ideal values for childbearing age, i.e. pH 4-4.5.
Help from vitamin D
Another interesting aspect in prevention is the role played by vitamin D. “In pregnancy, her deficiency triples the risk of bacterial vaginosis,” explains the gynecologist. “The first thing to do is therefore to measure the values with a simple blood test. If it is insufficient (i.e. less than 30 ng/ml), the correct treatment is to take a supplement, with the right intake (daily, weekly or monthly).’
“The lack of vitamin D is very frequent in the Italian population, especially in the winter months. Therefore, during routine blood tests, it should be dosed in all women, especially during pregnancy to avoid heavy obstetric and neonatal complications: bacterial vaginosis, but also the increased risk of diseases such as gestational diabetes, hypertension (pre-eclampsia), premature birth, caesarean section » concludes the gynecologist.
Another possible help can come from probiotics, which should allow to restore the “friendly” vaginal bacterial flora, through the application in the vagina of preparations containing lactobacilli, in the form of eggs or tablets.
Candida in pregnancy: not dangerous, but very annoying
Candida albicans is a fungus that lives physiologically in different parts of the body, such as the skin, vaginal mucosa and intestines. In particular, on the cells of the mucous membrane of the female genital tract finds optimal conditions for its growth: moisture, heat, sugars and an acidic “soil”. Characteristics that during pregnancy increase, because, under the stimulus of estrogen, the vagina becomes even more moist and rich in sugars. In addition, to promote an overgrowth of Candida can be a lowering of the immune defenses or diseases such as diabetes.
Candida vaginitis, unlike bacterial vaginosis, does not pose a danger to pregnancy, but it can be so persistent that it causes annoying symptoms even for months, so it is good to identify it as soon as possible and treat it scrupulously.
Vaginal disorders tend to resemble each other, but only in appearance: a more in-depth examination of the symptomatology can in fact reveal substantial differences, and thus help to distinguish the cause.
Recognizing the symptoms of vaginal Candida infections is simple: vaginal discharge is white (like cottage cheese), abundant and with a yeast-like odor. The biggest problem they cause is itching, often accompanied by swelling of the labia majora and minora.
In summary, here are the symptoms that characterize and differentiate these two vaginal infections:
| Appearance of secretions | Smell of secretions | Inflammatory symptoms | Vaginal pH | |
|---|---|---|---|---|
| Bacterial vaginosis | Milky and homogeneous greyish-white secretions, more or less abundant | Unpleasant smell, resembling that of spoiled fish | Absent | > 4-4,5 |
| Candidiasis | Whitish, granular secretions, similar to ricotta and tend to be abundant | Not unpleasant, but yeast-like odor | Itching, burning and redness | 4-4,5 |
For the treatment of Candida infections, antifungal products are used in creams, to be inserted into the vagina with an applicator, or candles, tablets or eggs.
After a couple of weeks from the end of the treatment, a second cycle of therapy is advisable because inactive spores can survive that “bloom” and because during the infection phase the woman contaminates clothing, sheets and towels with spores, which can then cause a new infection because they also resist washing at high temperatures.
The risks of candida infection in pregnancy increase if there are children under three years of age in the family (often carriers of spores even without symptoms) or if the woman has taken antibiotics. In addition, it is also good to treat the partner, so as to avoid a ping-pong effect within the couple.
Candidiasis is not dangerous for the fetus, but it is good to treat it before labor begins because, during vaginal delivery, it is possible that the infection passes to the newborn, who can develop candidiasis of the oral mucosa, better known as thrush.
To prevent recurrent Candida infections it is good to wear breathable underwear, for example cotton or other natural fibers, and use delicate detergents, specially formulated for intimate hygiene.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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