Yeast Infections

Yeast infections are one of the most common infections occurring in women. Although they are rarely dangerous, they can be very bothersome and uncomfortable. A number of ways to prevent yeast infections are discussed here, as well as information on treating both acute and chronic yeast infections. Simply put, a yeast infection is an overgrowth of yeast that is normally found in the vagina. All people, no matter how "clean" they are, have bacteria, viruses, and yeast in their body. Some of these, like intestinal bacteria, are critical for our survival, whereas others, like the HIV virus that causes AIDS, can be deadly. Yeast infections are caused by a fungus, usually candida albicans, that grows rapidly, taking over the normal bacteria found within the vagina. Yeast infections are not so much "caught" (although they may be passed back and forth between sexual partners) as "grown" from one's own yeast cells within the vagina. The classic example of this is the increased chance of having a yeast infection after taking antibiotics. The antibiotics reduce the normal bacteria in the vagina, and the yeast seize the opportunity and reproduce rapidly, causing a yeast infection.

We know that while some women simply get yeast infections once in a great while, others are susceptible to them because of certain risk factors. In the past birth control pills were thought to increase the chance of yeast infections, but current pills have much lower hormone doses than in the past, and are not thought to lead to yeast infections. Also, some women may feel that yeast infections imply they are not "clean enough down there" but this is not the case. Risk factors for yeast infections include:

• Recent antibiotic use, for example for a urinary tract infection.

• Wearing tight clothes, particularly non-cotton underwear or pants.

• Wearing moist clothing for extended periods, such as workout or swimwear.

• Having diabetes.

• Having leukemia or AIDS, both conditions that damage the immune system. Obesity.

Most women know the common symptoms of a yeast infection, which include itching, burning, a white discharge, pain with intercourse or tampon use, or redness and irritation of the vulva (the outside "lips" of the vagina). Some women get all of these symptoms, while others have none. This is important now that there are over-the-counter medications for yeast infections. Medical studies have shown that most women misdiagnose their own yeast infections, and can miss other important vaginal infections, such as trichomonas, gardnerella, chlamydia, or gonorrhea that may produce somewhat similar symptoms. Therefore, unless one is absolutely certain of the diagnosis, a visit to a health care provider experienced in women's health is necessary.

Diagnosing yeast infections involves a brief visit to your health care provider, who will perform a pelvic exam in order to look in the vagina. In many cases a small drop of vaginal discharge is taken and viewed under a microscope to look for yeast cells. Treatment for an acute yeast infection is rarely difficult and involves one of many oral or vaginal anti-fungal medications. There are many on the market. Most work equally well, but each patient's situation is different therefore your health care provider may want to try one versus another to treat your specific infection. Despite advertisements on television and in magazines, no one prescription is necessarily better than another. In all cases, however, the medication should be used completely as directed in order to "wipe out" all the yeast.

Chronic infections or infections that recur frequently are often extremely distressing to the patient and frustrating to her health care provider. A systematic approach to these infections will usually yield appropriate treatment and relief of symptoms. Prevention, discussed later, is important, but if this is not successful, a thorough exam looking for diabetes or other causes is necessary. Furthermore, vaginal cultures may be necessary to determine if one's infection is caused by an unusual type of yeast that may be resistant to certain anti-fungal medications (such as candida glabrata or candida tropicalis). Treatment may require a long course of anti-fungal medications, painting the vagina and vulva with a purple medication called gentian violet, or using certain suppositories on a nightly or weekly basis. The treatment of chronic or frequently recurrent yeast infections involves a blend of the science and art of practicing medicine, and is rarely successful after only one visit. This will almost certainly require a number of visits to your doctor to "fine tune" the treatment, and may require careful monitoring for side effects. It is important to see a physician or other health care provider who is specifically comfortable and experienced managing complicated and chronic yeast infections. Unfortunately, treating the male partner, who may harbor yeast on his penis in about 10% of cases, does not seem to prevent recurrent infections in the female partner.

Preventing yeast infections is obviously more desirable than treating them. Wearing loose clothing, cotton underwear (or at least underwear with a cotton crotch panel), removing damp clothing soon after swimming or working out, and carefully drying the vulvar area after bathing will all help prevent yeast infections. Some advocate using a blow dryer on warm to briefly blow dry the vulva after bathing to insure adequate drying. Others suggest using vaginal or oral yogurt, which is a controversial method of preventing yeast infections. However, there are articles in the medical literature that support eating 8 ounces a day of yogurt containing lactobacillus acidophilus, which may reduce the yeast infection recurrence rate by threefold. IF you choose to do this, however, please make sure the yogurt you buy specifically contains lactobacillus acidophilus, as many do not. Some also advocate taking anti-fungal medications intravaginally or orally at specific intervals to prevent overgrowth of yeast. In some diabetic patients this is very helpful. Yeast infections are common and sometimes difficult to treat, but with the appropriate evaluation and treatment they can be effectively treated. Any symptomatic vaginal discharge should be evaluated to ensure proper treatment.

References:

D. Ashley Hill, M.D.

Associate Director

Department of Obstetrics and Gynecology

Florida Hospital Family Practice Residency

Orlando, Florida

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