Vulvovaginitis in pregnant women

Abstract

Keypoints• The balanced vaginal microbiome is the main factor defending the vaginal environment against infections. Lactobacilli play a key role in this regard, maintaining the vaginal pH within the normal range (3.8 to 4.5).• Hormonal and immune adaptations resulting from pregnancy influence changes in the vaginal microbiome during pregnancy. • An altered vaginal microbiome predisposes to human immunodeficiency virus (HIV) infection.• Bacterial vaginosis is the main clinical expression of an imbalanced vaginal microbiome.• Vulvovaginal candidiasis depends more on the host's conditions than on the etiological agent.• Trichomonas vaginalis is a protozoan transmitted during sexual intercourse.• The use of probiotics is not approved for use in pregnant women. Recommendations• All complaints of changes in the vaginal contents reported by the pregnant woman must be evaluated to rule out both the changes in the vaginal microbiome and other genital infections. • Microscopic examination for direct or Gram-stained examination should always be carried out when suspicious changes of infections are detected in the vaginal contents. • The Amsel's criteria and staining of the vaginal content smear according to Nugent criteria are used in the diagnosis of bacterial vaginosis in our country. • The use of metronidazole for seven days is the preferred treatment of bacterial vaginosis in pregnant women. Although oral and vaginal treatments are efficient, oral treatment for seven days is preferred. If there is any impediment to the use of metronidazole, oral clindamycin is also a more commonly used option. • The wet mount vaginal swab of the vaginal contents is indicated to complement the clinical examination in the diagnosis of vulvovaginal candidiasis. Culture and antifungigrams are only indicated in relapses. • Vulvovaginal candidiasis in pregnant women must be treated with imidazole derivatives vaginally for seven days, as oral antifungal medications are not approved for use in pregnant women. • The wet mount vaginal swab of the vaginal contents is the main test to confirm the diagnosis of trichomoniasis. • The choice for the treatment of vaginal trichomoniasis is oral metronidazole for seven days. Single-dose oral treatment or vaginal treatment produce results with higher failure rates. • The best strategy must be established in each service, aiming to include the partner in antenatal care.