Colpitis in pregnancy: what is it and how to treat?

An inflammatory disease of the vaginal mucosa, accompanied by noticeable discomfort in the area of the external genitalia, is called colpitis or vaginitis. The inflammation often extends to the vaginal part of the cervix or the vestibule of the vagina (vulvovaginitis). However, many have never heard of it. So what is colpitis in women during pregnancy?

This is a fairly common disease of the female reproductive system, caused by pathogenic or opportunistic microorganisms. Almost every woman has encountered colpitis throughout her life, and many of them - during pregnancy, since the body of the expectant mother partially loses the ability to resist infection.

The next question: what to do? Is colpitis dangerous during pregnancy? It is imperative to listen to the recommendations of the attending physician. The disease is accompanied not only by significant discomfort, but can have a negative impact on the outcome of pregnancy. The danger is not so much colpitis, but the lack of its treatment.

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Causes colpitis in pregnancy

Pregnancy itself is a predisposing condition for the development of pathogenic microorganisms. Physiological immunosuppression and decreased vaginal acidity under the influence of sex hormones are specific causes of colpitis during this period. Against this background, any microorganism begins to multiply almost unhindered. And there are many of them - gonococci, trichomonads, chlamydia, staphylococci and other microorganisms inhabiting the vaginal mucosa. Alkalization of the vaginal environment favors the disruption of its microbiocenosis and the development of candidiasis, gardnerellosis, and entire microbial associations.

In addition to this, there are risk factors for vaginal inflammation that are not related to pregnancy:

• damage to the integrity of the vaginal mucosa - mechanical (tight underwear, jeans), chemical, thermal, or a combination of these;
• vaginal dysbacteriosis due to long-term antibacterial therapy or adherence to douching as a hygienic procedure;
• promiscuous sex life;
• sensitization to intimate hygiene products or intravaginal medications;
• neglect of intimate hygiene rules;
• diseases of the endocrine system, autoimmune pathologies;
• dystrophy of the vaginal mucosa
• anatomical anomalies;
• predominance of spicy foods and fast carbohydrates (flour, sweets) in the diet;
• previous illnesses, unfavorable environmental conditions.

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Pathogenesis

Specific colpitis develops mainly due to invasion of pathogenic microorganisms during coitus. After their introduction, the vaginal mucosa becomes inflamed - upon examination, swelling, hyperemia, and bleeding with careless touch are detected.

The mechanism of development of non-specific colpitis: serous → mucous → purulent catarrh.

In addition, inflammation can be primary, when its development occurs as a result of infection of the vaginal mucosa, or secondary - descending from the uterus or ascending from the vulva.

Against the background of pregnancy and other factors mentioned above that increase the likelihood of developing inflammatory phenomena on the vaginal mucosa, pathogenic microorganisms become active and begin to actively multiply. The sex glands begin to actively produce vaginal secretions to remove the waste products of microorganisms. This is the reason for the secretion of abundant discharge, in which both the culprits of the inflammation and the products of their metabolism are found. Other symptoms appear that correspond to the type of colpitis.

The disease occurs in acute, subacute and chronic forms. During pregnancy, a latent infection may become aggravated. The diagnosis of colpitis implies that the inflammation is limited to the vagina.

Statistics of morbidity state that colpitis is diagnosed quite often in expectant mothers – more than ¾ of pregnant women have suffered from this disease. There is no correlation between the period of pregnancy and the probability of getting sick. It is possible at any stage, but acute colpitis or exacerbation of chronic colpitis in the last months, especially before childbirth, is considered the most dangerous.

Studies of the etiology of the disease indicate that in almost 80% of cases of colpitis, two or more microorganisms are isolated, with opportunistic flora predominating among them. Moreover, aerobes, by absorbing oxygen, create favorable conditions for the reproduction of anaerobes. Thus, almost all microorganisms, except for lacto- and bifidobacteria, can participate in the development of inflammation of the vaginal mucosa.

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Symptoms colpitis in pregnancy

The first signs that attract attention are discharge that stains underwear and causes discomfort. They are quite abundant, the color and smell depend on the type of pathogen. When they get on the genitals, they cause irritation - itching, swelling, hyperemia. The genitals itch outside and inside, in addition, patients often complain of pain, burning and stinging during emptying the bladder, discomfort during sexual intercourse. The mucous membrane is covered with a grayish coating, which, when removed, reveals a bleeding surface. Over time, the epithelium of the vagina becomes covered with bright red spots or tubercles. Women complain of pain in the lower abdomen, radiating to the lower back. In general, the symptoms in pregnant and non-pregnant women are no different.

Acute colpitis begins suddenly and is characterized by pronounced symptoms, sometimes a woman's body temperature may rise, which is accompanied by general signs of intoxication. Without treatment, the symptoms become less pronounced, the condition improves, the amount of discharge decreases and the disease becomes chronic. During examination, widespread dilation of blood vessels or their foci are detected. The vaginal epithelial surface undergoes significant changes due to degenerative processes and may be absent in some areas, visually it looks as if pus is oozing directly from rough and compacted walls. Chronic colpitis occurs with periodic exacerbations, which can even be caused by a change in diet.

Types of colpitis vary depending on the pathogen. The most common are inflammatory processes caused by:

1. Non-specific pathogens (E. coli, staphylococci, streptococci and other bacteria present in small quantities in the vaginal microbiocenosis or getting there from the anus and not being able to develop with normal acidity and immunity). This type of inflammation is most common. Colpitis in early pregnancy mainly belongs to this type. It manifests itself as moderate odorless discharge, the color of which varies from transparent-whitish to brownish, mild itching. Long-term non-specific colpitis during pregnancy can cause a feeling of heaviness, sometimes heat, in the lower abdomen, radiating to the lower back.
2. Fungi of the genus Candida - the reason for their spread is similar to the previous one, as is the frequency of occurrence. Candidal, yeast colpitis during pregnancy is accompanied by white thick discharge of the consistency of slightly squeezed cottage cheese. Curdy pieces collect in the folds of the external genitalia, causing quite severe itching, irritating the epithelium, which is manifested by swelling and redness. A sharp sour smell of discharge is characteristic, emptying the bladder can be accompanied by a burning or stinging sensation.
3. Bacterial vaginosis (gardnerellosis) - discharge is abundant, grayish-white, viscous, with the smell of rotten fish, sometimes foaming. It practically does not cause itching, pain above the pubis occurs in advanced cases.
4. Trichomonas colpitis during pregnancy is also not uncommon. This is a fairly common venereal parasitic infection. It is transmitted through sexual contact. Vaginal discharge is abundant, foamy, yellowish-gray or greenish in color, with an unpleasant odor. Itching from moderate to strong, burning during emptying the bladder is also possible.
5. Gonorrheal colpitis - liquid, abundant, odorless purulent discharge, urination is accompanied by cutting, pain is felt above the pubis. The external genitals do not itch much, sometimes there may be no itching. Periodic bleeding (spotting) and pain above the pubis, pressure in the lower abdomen are often observed. The acute form of the disease is accompanied by pronounced symptoms, pain and fever, swelling and hyperemia of the external genitals. Gonorrhea in women is often asymptomatic, so during pregnancy, the signs of the disease may not bother too much. However, gonorrheal colpitis in a pregnant woman can have the most unpleasant consequences for her and the child.

Colpitis is caused in most cases by microbial associations, therefore the symptoms are mixed, for example, discharge may have a cheesy consistency and a gray-green color, since fungi also develop well against the background of colonization by pathogenic flora. Trichomonas get along well with gonococci and such symbiosis leads to difficult diagnostics and quite unpleasant consequences. Therefore, if discharge of any type and consistency, itching or moderate, quite tolerable pain in the lower abdomen appears, a pregnant woman must inform her gynecologist about this.

Sanitized colpitis during pregnancy is probably the most dangerous. This is an inflammation that was not treated in time, proceeding in a latent form without pronounced symptoms. It can be detected only by passing a smear, and this procedure is carried out twice for pregnant women. If leukocytosis, a small number of Doderlein sticks, coccal flora, E. coli, as well as specific pathogens are detected in the smear, it is necessary to undergo treatment without refusing, despite the absence of symptoms, since colpitis during childbirth, exacerbated in the last days of gestation, can infect the child during passage through the birth canal.

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Complications and consequences

Pregnant women should not ignore the symptoms of colpitis, since the consequences of such an irresponsible attitude can be dangerous both for the expectant mother and for her unborn child.

Firstly, it is necessary to take into account the ability of pathogens to ascending infection. In the absence of treatment, they migrate with the blood and lymph flow, into the uterus and appendages, urinary organs, colonizing ever larger spaces and causing an inflammatory process.

Secondly, much depends on the type of infectious agent. Such pathogens as trichomonads are very mobile themselves, moreover, gonococci use them as a means of transport, therefore combined infection with these microorganisms, which is not an exceptional rarity, is especially dangerous.

Thirdly, the presence of colpitis during childbirth (open uterus) significantly increases the likelihood of infection of the uterus and appendages and the occurrence of diseases such as endometritis, salpingo-oophoritis, leading to the development of adhesions, tubal obstruction, ectopic pregnancy and persistent infertility. These are, of course, long-term consequences.

More recent complications during childbirth include ruptures of the vaginal walls and cervix, as swollen, ulcerated mucous membranes lose elasticity. There is a risk of significant trauma to the birth canal and the development of massive hemorrhages.

Colpitis is a source of infection, and after childbirth, the sutures may fester for a long time, secondary inflammatory processes with suppuration and necrosis may develop. Purulent inflammation is often complicated by the formation of an infiltrate in the vaginal wall and spreads to adjacent tissues (paracolpitis), and occasionally - an abscess.

In general, long-term inflammation becomes chronic and manifests itself through frequent exacerbations with the likelihood of developing ascending and generalized inflammation.

According to medical statistics, colpitis is quite often the cause of a frozen pregnancy. The probability of miscarriage in expectant mothers with colpitis, especially specific, increases by 1.2-1.4 times compared to those who do not have it.

The presence of an inflammatory process in the vagina can have other negative consequences for the child.

Some pathogens overcome the placental barrier and infect the amniotic fluid and placenta, which can lead to the development of vascular and cerebral anomalies in the embryo, chorioamnionitis, placental insufficiency, and fetal infection in the early stages. All this can result in the birth of a child with developmental anomalies, congenital pneumonia, immunodeficiency, and even death.

The child can also become infected during childbirth, which causes a number of complications in the newborn, such as blenorrhea.

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Diagnostics colpitis in pregnancy

The diagnosis of colpitis is quite obvious, and the gynecologist establishes it during a visual examination based on specific signs: the presence of noticeable vaginal discharge, the appearance and smell of which allows one to assume the type of colpitis, swelling and redness of the genitals, often the detection of erosion of the cervix (as a complication of colpitis), as well as the presence of complaints of a certain discomfort in the patient.

A smear of vaginal discharge is taken to determine the pathogen. This may include microscopic examinations, culture tests, which also allow determining the sensitivity of the microorganism to certain antibiotics. If the laboratory has the capacity, a PCR test is performed, which allows the pathogen DNA to be determined in a short time.

Instrumental diagnostics is designed to identify the likelihood of miscarriage, fetal developmental abnormalities, and placental insufficiency. Pregnant women are prescribed ultrasound examination, starting from the second trimester – with Dopplerography. If necessary, a colcoscopic examination is performed.

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Differential diagnosis

Differential diagnostics is carried out on the basis of a gynecological examination, laboratory and instrumental studies. Colpitis is differentiated by the form of the disease, origin and type of pathogen, and also the degree of damage to the vaginal walls and its transition to other tissue layers is assessed. Parametritis and vaginal hematoma are excluded.

Treatment colpitis in pregnancy

Trying to cure colpitis at home is not worth it. The favorable outcome of the treatment and the pregnancy itself will depend on the timeliness of contacting a doctor.

During the treatment, the woman must comply with several conditions. Restrictions are introduced into the diet - the patient must exclude spicy dishes, pickles, smoked foods, sweets and baked goods. Sexual activity is excluded during the treatment period; if pathogens of venereal diseases are detected, both partners must be treated.

Medicines are prescribed depending on the type of pathogens detected. Systemic therapy is undesirable for pregnant women, so if possible, they try to get by with local drugs. Most often, suppositories for colpitis are used during pregnancy.

Vaginal suppositories Hexicon (active ingredient – antiseptic chlorhexidine bigluconate) are active against pathogens of fairly common sexually transmitted infections – trichomonas, gonorrhea, chlamydia, mycoplasma, yeast fungi and dermatophytes. They have a local effect and do not enter the systemic bloodstream. They are approved for use in pregnant women even in the earliest stages. The only contraindication is individual intolerance.

Soap and products containing an anionic group neutralize the activity of chlorhexidine, however, this does not apply to external washing, since suppositories are inserted deep into the vagina. For therapeutic purposes, one suppository is used every 12 or 24 hours for five to ten days. As part of complex therapy, not simultaneously with local preparations containing iodine, not prescribed.

Intravaginal tablets Terzhinan are a combination drug, the active components of which are:

• Ternidazole is active against Trichomonas, Gardnerella and some other anaerobes;
• Neomycin sulfate - disrupts the functions of the RNA of bacteria that may be present in microbial associations that cause inflammation of the vaginal mucosa: corynebacteria, listeria, Staphylococcus aureus, Escherichia coli and Haemophilus influenzae, Proteus, Salmonella, Shigella, Yersinia, Klebsiella and many others;
• Nystatin is a well-known fungicide, especially active against yeast fungi of the genus Candida;
• Prednisolone is a corticosteroid, anti-inflammatory and anti-allergic component.

A drug with a broad spectrum of action, suitable for the treatment of the most common types of colpitis.

May cause local sensitization reactions. During pregnancy - only as prescribed by a doctor. One tablet is administered intravaginally every 12 or 24 hours. Before administration, the tablet is moistened with clean water, and after - it is necessary to lie down for a quarter of an hour. The duration of treatment is determined by the doctor.

Pimafucin - vaginal suppositories are considered one of the safest and are not contraindicated for pregnant women. The main component of the drug is the antibiotic Natamycin, active against candidiasis pathogens, disrupting the integrity of the cell membranes of fungi. There are no known cases of resistance and allergic reactions to this substance. Candida ablicans, which cause the vast majority of candidal colpitis, are most sensitive to the drug, however, in cases of mixed infections, suppositories may not be effective. Prescribe one suppository per day for three to six days.

Polygynax is a combination drug in the form of vaginal suppositories with a broad spectrum of action, containing three antibiotics:

• Neomycin sulfate - disrupts the functions of the RNA of bacteria that may be present in microbial associations that cause inflammation of the vaginal mucosa: corynebacteria, listeria, Staphylococcus aureus, Escherichia coli and Haemophilus influenzae, Proteus, Salmonella, Shigella, Yersinia, Klebsiella and many others;
• Polymexin B sulfate is a polypeptide antibiotic, active mainly against gram-negative bacteria; it disrupts the osmotic stability of bacterial walls and inhibits the growth of pathogenic microorganisms;
• Nystatin is a well-known antifungal drug to which Candida yeast fungi are particularly sensitive.

The active ingredients do not affect the activity of Doderlein bacilli. It is used for mixed infections, non-specific bacterial vaginosis, candidiasis.

Contraindicated for patients who are intolerant to the active ingredients of the drug, as well as those with allergies to soy and peanuts. During pregnancy, use only as prescribed by a doctor.

Sometimes pregnant women cannot do without the prescription of systemic drugs, especially in the case of gonorrheal colpitis. In this case, the woman is hospitalized, and both local drugs and antibiotics are prescribed orally. Erythromycin and Josamycin are considered safe during pregnancy.

Erythromycin is the first representative of the macrolide group, considered the most non-toxic, has a natural origin. It is considered an alternative, since many microorganisms have already acquired resistance to this drug and its effectiveness is considered lower than that of later macrolides. It has a bacteriostatic effect in therapeutic doses, like all representatives of this group, penetrating the cell wall and binding to a fragmentary section of the bacterial ribosome, preventing the normal synthesis of its protein, inhibiting the transfer of peptides from the acceptor site to the donor site. In addition to the fact that macrolides are able to stop the growth and reproduction of bacteria, they have some immunomodulatory and anti-inflammatory ability.

Josamycin, a natural, but more modern representative of the same class of antibiotics, is characterized by higher activity than Erythromycin. Unlike other macrolides, it practically does not suppress the beneficial microflora of the gastrointestinal tract. Resistance to it develops less often than to other representatives of this group.

Vitamins and proper nutrition will help support the immunity of a pregnant woman during treatment. The doctor usually recommends taking vitamin and mineral complexes intended for expectant mothers, Elevit, Prenatal, Femibion.

Folk remedies

Colpitis in folk medicine is treated by douching with various compositions, including infusions and decoctions of medicinal herbs. However, pregnant women should avoid douching and replace this procedure with medicinal sitz baths or washing (irrigation) of the external genitalia with medicinal solutions.

Such procedures will help reduce itching and burning, and quickly cope with hyperemia and swelling of the outer labia.

Local herbal treatment of colpitis during pregnancy is not contraindicated, even if the decoction of this medicinal plant is not used internally during pregnancy.

The most preferable is chamomile, it contains chamazulene, which has the ability to relieve inflammation and pain, and of all the herbs, chamomile is the most hypoallergenic.

For the bath, take six tablespoons of dried and crushed flowers, brew them in a three-liter glass jar. Do not boil, since chamazulene is afraid of boiling, but simmer in a water bath for ten minutes. Cool to body temperature (36-38℃), strain into a basin and take a bath, sitting in it for a quarter of an hour.

For such baths you can use infusion of calendula (antifungal activity), St. John's wort, yarrow, coltsfoot.

For irrigation and washing, the following infusions are made:

• oak bark - steam a tablespoon of oak bark with 300 ml of boiling water, simmer for a quarter of an hour in a water bath, let cool to 36-38℃, strain and use everything at once;
• Rosehip infusion has anti-edematous properties; dry crushed fruits (100g) are poured into a thermos with boiling water (500 ml) overnight, filtered in the morning and the procedure is performed, then an infusion is prepared in the same way, which is used before bedtime.

Local treatment is carried out until symptoms disappear.

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Homeopathy

Professional homeopaths can successfully cure non-specific or candidal colpitis in pregnant women; homeopathic preparations have a milder effect. In cases of sexually transmitted infections, the effectiveness of homeopathy is questionable, unless it can smooth out the negative consequences of treatment.

Prescriptions should be made by a homeopathic doctor. In case of candidal colpitis, symptomatic remedies are considered to be Kalium muriaticum, Thuja (Thuja occidentalis). Abundant discharge with an unpleasant odor and discomfort require the prescription of Alumina or Berberis, damage to the integrity of the vaginal epithelium suggests the prescription of Cantharis or Lachesis. Sulfur (Sulphur) and sulfuric acid (Sulfuricum acidum) preparations are widely used.

Of the pharmaceutical preparations prepared in homeopathic dilutions, the doctor may prescribe Gynecoheel drops for acute or chronic inflammation of the vaginal mucosa, as well as its vertical spread. Its components have a comprehensive effect on the female genital area:

Apis mellifica (Honey bee venom) – swelling of the genitals, traces of blood in the discharge, general malaise;

Naja tripudians (Indian cobra venom) – normalizes the functions of the left ovary, eliminates pain;

Vespa crabro (Common Hornet) – used for cervical erosions and ovarian pathologies (discomfort on the left side);

Chamaelirium luteum (Yellow Chamaelirium) – prevention of miscarriage, normalizes hormonal levels;

Lilium lancifolium (Tiger lily) – heaviness and pressure in the lower abdomen, lower back pain, emotional disorders;

Melilotus officinalis (Melilotus officinalis) – copious leucorrhoea, accompanied by cutting, pain and aching sensations in the lumbar region

Viburnum opulus (Viburnum opulus) – suprapubic pain;

Ammonium bromatum (Ammonium bromide) – used in cases of inflammatory processes affecting the ovaries and fallopian tubes;

Aurum jodatum (Aurum iodatum) – normalizes the functioning of the endocrine system;

Palladium metallicum (Metallic palladium) – inflammatory processes of the female genital organs, manifested by abundant pathological secretion;

Platinum metallicum (Metallic platinum) – bleeding, hormonal imbalances, neoplasms of the genitals.

The doctor decides whether to treat a pregnant woman. It is prescribed with caution to patients with chronic thyroid and liver diseases, after head injuries. It is taken three times a day a quarter of an hour before meals as follows: drip ten drops into 100 ml of water and drink the solution, holding the liquid in the mouth.

Combinations with any drugs are possible; to achieve greater therapeutic effect, it is recommended to combine Ginekoheel drops with oral forms of Traumeel S.

Acute candidal or mixed colpitis, accompanied by pronounced symptoms, can be treated with homeopathic tablets for sublingual resorption Bioline Candida (Walsh Pharma, USA). It is also used to prevent relapses in the chronic form of the disease. The drug has an immunomodulatory effect and contains ten components in different dilutions:

Baptisia tinctoria (Baptisia) – indicated for acute conditions, one of the symptoms of which is a putrid odor of discharge;

Bryonia (Bryoniya) – indicated for acute conditions and pain, including in the ovaries;

Echinacea angustifolia (Echinacea angustifolia) - discharge in women, more abundant in the evenings, pain when urinating;

Eupatorium perfoliatum (Eupatorium perfoliatum) – itching in the clitoral area;

Helonias dioica (Yellow Chamelium) – vulvovaginitis with profuse leucorrhoea and pain in the uterus;

Thuja occidentalis (Thuja) – urethritis, cervicitis, oophoritis, hormonal disorders; acts on the mucous membrane of the genitourinary organs;

Viscum album (White mistletoe) – used to treat diseases of the genital area;

Kreosotum (Kreosotum) – swelling and itching of the genitals, itching in the urethra during emptying of the bladder;

Nosodes Candida albicans, Candida parapsilosus – revive defense mechanisms.

The tablets are kept under the tongue until completely dissolved, in acute conditions - one unit every two hours, then for two weeks - one tablet four times a day.

Prevention

Preventing the appearance of colpitis symptoms during pregnancy is not too difficult. The greatest danger is the inflammatory process caused by sexually transmitted infections. Therefore, when a couple plans to become parents, both partners need to be examined for latent STIs. If pathologies are detected, it is necessary to undergo treatment in advance, and also to observe monogamy. A pragmatic attitude to your health can save you from many problems. This also includes proper nutrition, a healthy lifestyle and the absence of bad habits, which will significantly strengthen the immune system.

Non-specific colpitis that occurs in a pregnant woman due to physiological reasons is still less dangerous and easier to treat, and sometimes goes away without treatment when the condition stabilizes.

It is also necessary to maintain intimate hygiene, but without fanaticism. Disruption of the vaginal microflora is sometimes observed in women who are "obsessed" with cleanliness. It is necessary to remember that douching is a therapeutic, not a hygienic procedure.

It is recommended to wear comfortable panties made from natural fabrics, and avoid thongs, lace synthetic items, and tight trousers.

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Forecast

Timely diagnosis and adherence to doctor's recommendations significantly increases the favorable prognosis of colpitis during pregnancy, caused by any reasons.

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