Vaginal Infections and Other Conditions

Core Concepts

The healthy vaginal ecosystem

Normal discharge (physiologic leukorrhea) is clear to milky white, mild-smelling, and varies with the cycle and pregnancy — pregnancy itself increases normal discharge, which is not an infection. The acidic environment is maintained by lactobacilli; when they decline, the environment becomes less acidic, setting the stage for infection. Assessment of any complaint therefore starts with: "What is this person's baseline, and what changed?"

Bacterial vaginosis (BV)

BV is a polymicrobial imbalance, not a single-organism infection: lactobacilli decrease while mixed anaerobes (Gardnerella vaginalis is commonly involved) overgrow. The classic picture is thin, grayish-white discharge with a fishy odor, often stronger after intercourse or menses, with little or no itching. BV is not typically classified as an STI, but sexual activity and new or multiple partners are associated with it. Douching is a recognized risk factor because it washes away protective lactobacilli. In pregnancy, BV has been associated with preterm birth and preterm rupture of membranes; whether screening and treatment prevent those outcomes is still under study, so nurses should present this as an association, not a certainty.

Vulvovaginal candidiasis (yeast)

Yeast infections are fungal overgrowths, most often Candida albicans. The hallmark is intense itching with thick, white, "cottage cheese" discharge, plus redness and sometimes pain with urination or intercourse. Triggers include recent antibiotics, poorly controlled diabetes, immunosuppression, and pregnancy itself — higher estrogen makes vaginal tissue a better home for yeast. Candidiasis is not usually sexually transmitted. Over-the-counter antifungal self-treatment is common but appropriate only after a provider confirms the diagnosis — BV treated with antifungal cream simply continues untreated, and self-treatment during pregnancy should always be avoided.

Trichomoniasis

Trichomoniasis is caused by the protozoan Trichomonas vaginalis and is sexually transmitted. The classic discharge is frothy, yellow-green, and often malodorous, with itching and burning; some people show small red spots on the cervix ("strawberry cervix"). Many infected people have no symptoms, so sexual partners may need treatment even without symptoms. Untreated trichomoniasis in pregnancy has been associated with adverse outcomes; treatment decisions are the provider's, made with the pregnancy in mind. Partner notification and treatment prevent reinfection.

Noninfectious causes

Not every discharge is an infection. Atrophic vaginitis occurs with low estrogen (menopause, breastfeeding), leaving thin tissue that burns or itches. Contact irritation comes from soaps, bubble bath, perfumed products, and spermicides. A retained foreign body such as a forgotten tampon causes a foul, sometimes bloody discharge. These are managed by removing the irritant — not by antibiotics — which is why history matters as much as physical findings.

The nurse's role: assessment and teaching

Assessment covers onset and timing, color, odor, amount, and consistency of discharge, itching or burning, recent antibiotics, hygiene practices, and sexual history when relevant. Specimen collection follows facility policy; collection is less reliable during menstruation or soon after douching or intercourse. Teaching priorities: wipe front to back, avoid douching and perfumed products, wear cotton underwear, complete prescribed treatment even after symptoms improve, and return if symptoms persist. Diagnosis and treatment belong to the licensed provider; the nurse's scope is assessment, support, and education.

Common Confusions