Patients frequently present to their health care provider with complaints of yeast infection symptoms. Other terms that are used to describe yeast infections include yeast vaginitis or vaginal candidiasis. The symptoms of this type of infection usually include itching and irritation to the vulva around the opening of the vagina.
Yeast infections are more common during times of menstruation (having monthly periods) and also after taking antibiotics.
There is no evidence that vaginal yeast infections are related to poor hygiene or tight synthetic clothing.
Other symptoms of yeast infections:
1) Pain with urination – can be confused with a urinary tract infection
2) Itching or irritation around the opening of the vagina
3) Pain with intercourse
4) Watery or white colored vaginal discharge
5) Red or swollen vaginal tissues
The symptoms of yeast infection can be confusing because they can be similar to a number of other disorders such as a bacterial infection of the vagina, urinary tract infection, trichomoniasis, or common dermatitis (inflammation of the skin). Most of the time the patient may not know if the itching or irritation is caused from yeast or another cause and this leads them to see a medical provider.
Causes of yeast infection: Candida is the name of the yeast that causes the infection and it normally lives in the intestines and vagina. Most of the time Candida causes no symptoms. If it grows out of control (which can be due to increased stress, antibiotic use, or stress to the immune system), it can overgrow and cause symptoms.
Risk factors for yeast infection: Often there are no underlying health problems that lead to yeast infections in women, but several factors may increase the chances of developing an infection including:
1) Antibiotics – most antibiotics kill lots of bacteria including those that normally live in the vaginal area. The bacteria that are normally found in the vagina help protect this area from being overgrown with yeast. Antibiotics can kill off these bacteria and lead to an increase of the normal flora of yeast in the vagina
2) Pregnancy can increase the chances of yeast infection because there is a normal increase in the amount of vaginal discharge.
3) Diabetes causes an elevation of blood sugars which can lead to an increase in the likelihood of a yeast infection
4) Hormonal contraceptives such as birth control pills, vaginal rings or patches that contain estrogen can sometimes increase the chance of yeast infection in some people.
5) Contraceptive devices such as diaphragms, vaginal sponges and IUDs can also increase the chance of a yeast infection. Spermicides usually don’t cause yeast infections, but can lead to vaginal irritation.
6) Increased sexual activity can lead to a yeast infection. The reason for this may be related to changes in the concentration of bacteria within the vagina that happen with sexual intercourse. Yeast infections are not considered a sexually transmitted infection.
Diagnosis: Sometimes women who have symptoms of a yeast infection will diagnose themselves and seek treatment with over the counter medications. One study showed that only 11% of women accurately diagnosed their infection. Women who previously had a yeast infection were slightly more accurate (35% correct). The general recommendation is for women who have symptoms consistent with yeast infection be be evaluated by a medical provider. The exam usually consists of examination of the vulva and vagina and sometimes a swab is used to collect a sample of the discharge to look for yeast.
Treatment: You may be treated with oral or vaginal medication for yeast infection (or both).
Vaginal treatment: Most of the time the treatment includes a cream or tablet that is placed into the vagina at bedtime with an applicator. There are several different treatment options some of which are 1, 3 or 7 days in duration. The vaginal treatment seems to be more effective in reducing the vaginal irritation quicker than the oral medications.
Oral treatment: Diflucan is a very common oral medication for treating yeast infections. Most of the time only one dose is needed, however a second dose given 3 days or so after the first dose may be recommended for some patients.
If you’re not feeling better within a few days after starting the treatment, make sure you call the office of your medical provider to let them know.
Recurrent vaginal yeast infections: There are about 5-8% of women who have vaginal yeast infections that come back repeatedly. If the patient has more than 4 infections in one year, we call this recurrent vaginal yeast infection.
There is no evidence that eating yogurt or other products containing live lactobacillus acidophilus or applying these products vaginally will benefit women with recurrent vaginal yeast infections.
A persistent infection can be cause from a less common species of Candida called Candida glabrata or Candida krusei and in these less common species, we use different medications to treat them.
Treatment of recurrent vaginal yeast infections: Most of the time we use a longer course of anti-yeast medication in patients who have recurrent infections, often between 7 and 14 days for a topical cream or suppository or if the oral medication is used, it is taken with a 2nd dose 3 days later and possibly a 3rd dose 6 days later. Some patients are started on preventative treatment with oral or vaginal creams once per week.
Treatment of a sexual partner: Vaginal yeast infections are not a sexually transmitted infection and most experts do not recommend treating a sexual partner.
1) Diabetes: Keep blood sugars under good control in diabetic patients
2) Antibiotics: For patients who frequently get yeast infections after taking antibiotics, we often will prescribe a dose of fluconazole at the start and end of antibiotic therapy to prevent post-antibiotic vulvovaginitis.
3) Patient awareness: Patients who are using hormone birth control products or contraceptive devices should be aware of the increased risk of yeast infections with these products.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO