Vaginal Yeast Infections During Pregnancy

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Also known as a Candida infection, or Candidiasis, or a yeast infection, a fungal infection in the vagina is an infection with any of several species belonging to a genus (group) of fungus called Candida. Fungi (singular fungus) constitute one category of organisms that can infect the body. Other infectious organisms include bacteria and parasites. The latter are protozoa, meaning that they are tiny animals, each consisting either of a single cell, or of many cells. Like parasites, fungi also can consist of one or many cells, in contrast with bacteria, which exist only as single-celled organisms. Biologically, fungi have much more in common with humans than they have with bacteria. Consequently, it is much more difficult to kill fungi within the body without harming the body’s own cells than it is to kill bacteria without doing harm to the body. Medicine thus has a multitude of antibacterial medicines —antibiotics— but not as many medications that work well against fungal infections. But there are some good fungal medications and they’re easy to use, particularly against fungal infections that are not deep inside the body, because the medications can be applied directly to the infected areas.

Fungal infection of the vagina and vulva is called vulvovaginal candidiasis (VVC), or sometimes vulvovaginitis. VVC is an example of a superficial fungal infection, meaning that the infection is not deep within the body. This category of fungal infection also applies to fungal infections of the skin and nails and contrasts with fungal infections are classified as invasive, meaning that the fungus has infected the bloodstream (candidemia) and/or various parts of the body, including the lungs or the layers around the brain. Fungal infections of the vagina and vulva are very common, and women are at higher risk of developing a genital fungal infection. VVC is extremely common during pregnancy, just as they are common outside of pregnancy.. Most fungal infections in humans are caused by a species of fungus called Candida albicans. Among non-C. albicans infections, most are caused by any of four particular Candida species.

Pregnancy actually makes you more prone to Candida infection, especially during the third trimester. Vaginal Candida infections of produce very severe itching. Additionally, the infection can become chronic, meaning persistent and difficult to eliminate. However, VVA and other superficial Candida infections do not put the fetus at particular risk. In the case of VVC, the symptoms that you report, such as itching and vaginal discharge, plus findings on the physical examination will make the physician confident enough to make a diagnosis of C. albicans. In some cases, such as the presence co-existing health issues for which you are receiving medications, or a history of recurring Candida infections, your doctor make take a sample of the discharge for examination under a microscope, and for other laboratory tests. Looking at the samples under a microscope, the examiner (usually a clinical pathologist) will see characteristic features of the Candida organism, and help to determine if it is indeed C. albicans, if it is one of the four other Candida species that are fairly common, if it is a rare fungal infection, or if non-fungal organisms are complicating the picture.

It is possible for a pregnant woman to develop sepsis —infection throughout the body— from a viral infection or a fungal infection, if her immune system is compromised. However, most cases of sepsis are due to bacteria.

The main medications used against vaginal yeast infections are called triazole antifungals. These include clotrimazole, miconazole, fluconazole, and voriconazole. Another drug is called ciclopirox, whereas another category is called the polyene antifungals, which includes nystatin. Some of these medications are available as a topical cream, others to swallow orally, and some come in both oral and topical forms. For treating surface fungal infections and VVC, the first choice is always to use a topical creams; virtually all of the anti-fungal drugs that are given topically or into the vagina are considered safe to use during pregnancy. All topical and vaginal anti-fungal creams can be used safely by mothers who breastfeed. You can reduce your risk of developing a fungal infection by drying off as soon as you are finished swimming or exercising, and by using antibiotics only for the prescribed duration of treatment (don’t take extra).

David Warmflash
Dr. David Warmflash is a science communicator and physician with a research background in astrobiology and space medicine. He has completed research fellowships at NASA Johnson Space Center, the University of Pennsylvania, and Brandeis University. Since 2002, he has been collaborating with The Planetary Society on experiments helping us to understand the effects of deep space radiation on life forms, and since 2011 has worked nearly full time in medical writing and science journalism. His focus area includes the emergence of new biotechnologies and their impact on biomedicine, public health, and society.

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