Vaginal Infections and Other Conditions
Key Points
- Common vaginal infections include bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), each with distinct mechanisms and treatment pathways.
- Accurate diagnosis relies on focused symptom history plus targeted bedside/lab testing.
- Pregnancy and immunocompromised states alter risk and treatment safety choices.
- Nursing care emphasizes symptom relief, prevention education, and early recognition of complications.
Pathophysiology
Vaginal infections develop when normal protective vaginal ecology is disrupted or when fungal overgrowth occurs. BV reflects dysbiosis with reduced protective flora and increased anaerobic organisms, often presenting with thin discharge and characteristic odor. VVC reflects Candida overgrowth, often associated with hormonal shifts, diabetes, immunosuppression, or antibiotic exposure.
Diagnostic differentiation is critical because therapies differ. BV uses antimicrobial regimens; VVC uses antifungal regimens. Mixed or recurrent patterns may require confirmatory tests and longer treatment courses.
Related conditions in this section include group B streptococcal colonization in pregnancy, where prevention of neonatal transmission is a core perinatal safety goal.
Classification
- Bacterial dysbiosis condition: BV with elevated vaginal pH and clue-cell findings.
- Fungal overgrowth condition: VVC with pruritus, irritation, and curd-like discharge patterns.
- Pregnancy colonization condition: Group B streptococcal carriage requiring intrapartum management.
- Complication domains: Adverse pregnancy outcomes, reinfection, treatment intolerance, and STI co-risk overlap.
Nursing Assessment
NCLEX Focus
Prioritize distinguishing BV versus VVC based on symptom pattern, pH/wet prep data, and pregnancy/immunologic risk context.
- Assess discharge characteristics, odor, itching, burning, dyspareunia, and dysuria.
- Obtain exposure and risk history, including recent antibiotics, diabetes control, and immunosuppressive therapies.
- Review pregnancy status and gestational age before selecting medication options.
- Support diagnostic evaluation with point-of-care tests (pH, whiff, microscopy) and culture/PCR when indicated.
- Screen for overlapping STI symptoms and need for broader reproductive infection workup.
Nursing Interventions
- Teach condition-specific treatment adherence, expected symptom trajectory, and when to return for reassessment.
- Counsel against douching and other practices that disrupt vaginal flora.
- Reinforce condom considerations during topical/oil-based antifungal use.
- Provide pregnancy-specific education, including safe medication selection and GBS screening implications.
- Coordinate follow-up for recurrent or complicated infection patterns.
Self-Treatment Misclassification
Treating recurrent symptoms without diagnostic confirmation can miss resistant, non-albicans, mixed, or noninfectious causes.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| metronidazole | Oral and intravaginal BV treatment contexts | Avoid alcohol-interaction misconceptions and reinforce full-course completion. |
| azole-antifungals | Fluconazole and topical azoles for VVC | In pregnancy, topical azoles are preferred and oral fluconazole is generally avoided. |
Clinical Judgment Application
Clinical Scenario
A pregnant patient at 30 weeks presents with recurrent malodorous thin discharge and self-treated repeatedly with over-the-counter antifungal products without improvement.
Recognize Cues: Persistent symptoms despite antifungal use suggest non-candidal or mixed etiology. Analyze Cues: Misclassification may delay effective treatment and increase pregnancy-related risk. Prioritize Hypotheses: Priority is BV or mixed vaginitis requiring targeted diagnostics and pregnancy-safe treatment. Generate Solutions: Perform focused testing, initiate guideline-based therapy, and reinforce prevention counseling. Take Action: Escalate obstetric follow-up and monitor symptom response. Evaluate Outcomes: Symptoms resolve, recurrence risk decreases, and pregnancy safety is optimized.
Related Concepts
- sexually-transmitted-infections - Vaginal symptoms may overlap with STI syndromes and require differential testing.
- urinary-tract-infections - Dysuria and irritation can mimic urinary infection presentations.
- functional-reproductive-disorders - Hormonal changes can alter susceptibility and symptom patterns.
- culturally-competent-care - Sensitive, stigma-aware counseling improves adherence and follow-up.
- therapeutic-communication - Private and nonjudgmental communication supports accurate symptom disclosure.
Self-Check
- Which findings most reliably distinguish BV from VVC at bedside?
- Why is empiric repeated antifungal use risky without reassessment?
- How does pregnancy status change vaginal-infection treatment decisions?