Vaginal infections during pregnancy are common and treatable, but the approach differs from what you might use when you’re not pregnant. Some over-the-counter options remain safe, while certain oral medications carry risks that make them poor choices during this time. The type of infection you have determines the treatment, so getting the right diagnosis from your provider is the essential first step.
The three most common vaginal infections during pregnancy are yeast infections, bacterial vaginosis (BV), and trichomoniasis. Each has a different cause and requires a different treatment approach.
Yeast Infections: Safest to Treat on Your Own
Yeast infections are the most straightforward vaginal infection to manage during pregnancy. Over-the-counter antifungal creams, ointments, and suppositories are safe to use at any point in pregnancy and do not cause birth defects or pregnancy complications. The two most widely available options are clotrimazole and miconazole, both sold without a prescription.
The key difference from treating a yeast infection when you’re not pregnant: choose a seven-day formula rather than a shorter one- or three-day course. The longer treatment tends to work better during pregnancy, when hormonal changes can make yeast infections more stubborn and more likely to recur.
Oral antifungal pills are a different story. The FDA has flagged that high doses of oral fluconazole (400 to 800 mg per day) taken during the first trimester may be associated with a rare pattern of birth defects. A single low dose of 150 mg, the standard one-pill yeast infection treatment, does not appear to carry the same risk based on available human data. Still, most providers prefer topical creams and suppositories over oral medication during pregnancy simply because the topical route avoids any systemic exposure to the baby.
Bacterial Vaginosis: Why Treatment Matters
BV is the most common vaginal infection among women of childbearing age, affecting roughly 6 to 16% of pregnant women depending on the population studied. It occurs when the normal balance of bacteria in the vagina shifts, allowing certain organisms to overgrow. The hallmark symptoms are a thin grayish-white discharge and a fishy odor, though some women have no symptoms at all.
Untreated BV during pregnancy is linked to serious complications. Research has found that women with BV have a significantly higher rate of preterm birth before 34 weeks compared to women without it (roughly 23% versus 6% in one study). BV also raises the risk of premature rupture of membranes, infection of the amniotic fluid, and postpartum uterine infections. Babies born to mothers with BV infections show higher rates of respiratory distress and are more likely to need intensive care after birth.
Treatment for symptomatic BV during pregnancy typically involves a course of oral or topical antibiotics. Pregnant women can use the same regimens recommended for nonpregnant women, and oral therapy has not been shown to be superior to topical therapy for either curing the infection or preventing pregnancy complications. Cure rates range from about 70 to 85% depending on the specific regimen used. One medication to avoid during pregnancy is tinidazole, which animal studies suggest poses moderate risk to the fetus.
Trichomoniasis: Partner Treatment Is Critical
Trichomoniasis is a sexually transmitted infection caused by a parasite, and it requires prescription treatment. Symptomatic pregnant women should be tested and treated regardless of what stage of pregnancy they’re in. The standard treatment is a course of oral metronidazole.
What sets trichomoniasis apart from other vaginal infections is that your sexual partner must be treated at the same time. Without concurrent partner treatment, reinfection is almost guaranteed. Using condoms consistently is also important for preventing re-transmission during and after treatment. Tinidazole, an alternative used in nonpregnant patients, should be avoided during pregnancy due to potential fetal risk.
Group B Strep: A Different Kind of Screening
Group B Streptococcus (GBS) isn’t technically a vaginal “infection” in the traditional sense. It’s a type of bacteria that can colonize the vagina without causing any symptoms in you but can pose a serious risk to your baby during delivery. All pregnant women should be screened for GBS during the 36th or 37th week of pregnancy. If you test positive, you’ll receive antibiotics during labor to protect your newborn from getting sick. This screening happens with every pregnancy, even if you tested negative before.
What to Avoid During Treatment
Douching is one of the clearest risk factors for disrupting vaginal bacteria and should be avoided entirely during pregnancy. It doesn’t treat infections and can actually push bacteria further into the reproductive tract, worsening the problem.
Home remedies like tea tree oil and apple cider vinegar lack clinical evidence supporting their safety or effectiveness during pregnancy. While they’re popular online, there’s no reliable data showing they resolve vaginal infections, and introducing unregulated substances into the vagina during pregnancy carries unnecessary risk.
Probiotics: Helpful or Not?
Probiotics have generated interest for their potential to support vaginal health, and a systematic review found that probiotic and prebiotic products are generally safe during pregnancy and lactation without posing serious health concerns to mother or baby. Some probiotic products can alter vaginal bacterial composition and have been used to help prevent BV recurrence.
That said, probiotics are not a substitute for medical treatment of an active infection. One noted side effect is increased vaginal discharge, which occurred at nearly four times the rate compared to women not taking probiotics. If you’re considering adding a probiotic during pregnancy, it’s reasonable to do so alongside (not instead of) proven treatments.
Lowering Your Risk of Recurrence
Some vaginal infections, particularly BV and yeast infections, tend to come back during pregnancy because the hormonal environment that supports pregnancy also makes recurrence more likely. A few habits can help reduce that risk:
- Wear breathable cotton underwear and avoid tight-fitting clothing that traps moisture, since warm, damp environments encourage yeast overgrowth.
- Skip douching entirely. It disrupts the natural bacterial balance that keeps infections in check.
- Use condoms during sex, which reduces exposure to bacteria and parasites that trigger BV and trichomoniasis.
- Wipe front to back after using the bathroom to prevent introducing bowel bacteria into the vaginal area.
Getting the right diagnosis early is the most important thing you can do. BV, yeast infections, and trichomoniasis can all cause discharge and irritation, but each requires a completely different treatment. Using the wrong medication wastes time and allows a potentially harmful infection to persist.