Screening and Treatment for Vaginal Infections in Pregnancy

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Trichomonas vaginalis, a sexually transmitted vaginal infection, has been associated with preterm delivery and low birth weight.  Trichomonas infection can have unpleasant symptoms such as itching, heavy discharge, vaginal irritation, and odor. It also causes a chronic inflammatory condition and may facilitate HIV transmission. Women with symptoms of trichomoniasis should be evaluated with a saline wet mount or culture for the presence of trichomonads. Screening for Trichomonas in asymptomatic women is not recommended.

Metronidazole (Flagyl) 2 g orally in a single dose or 500 mg twice per day for seven days is the treatment for trichomoniasis in pregnancy, although many physicians wait until after the first trimester to initiate it.

It is pregnancy category B, but the manufacturer recommends caution in using it in the first trimester. One meta-analysis found no relationship between exposure to metronidazole in the first trimester and birth defects; however, it included only five studies. Tinidazole (Tindamax) is the only other drug available in the United States that is effective against Trichomonas and it is not recommended in pregnancy (category C). The outcome of treating trichomoniasis during pregnancy is uncertain. Treatment has not been shown to reduce the incidence of preterm birth.

Bacterial vaginosis is not an STI, but it is more common in sexually active women. Although many studies have shown an association between bacterial vaginosis and preterm birth, premature rupture of membranes, and low birth weight, it is not known whether the bacterial overgrowth causes these complications, or if it is a marker for intrauterine colonization. Screening for and treating bacterial vaginosis in asymptomatic pregnant women does not appear to reduce the risk of pregnancy complications.

BARBARA A. MAJERONI, MD, and SREELATHA UKKADAM, MBBS
State University of New York at Buffalo, Buffalo, New York

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