A yeast or candida infection occurs when the normal flora of the birth canal is disrupted leading to an overgrowth of the fungus, candida. This is also referred to as thrush. The symptoms can become so distracting and distressing, that it interferes with a womanís daily activities decreasing the quality of her relationships or even work productivity. Immediate treatment is required so that she can get back to normal life.
Candida organisms are a normal part of the flora detectable in up to 50% of women. It causes problems when there is an overgrowth leading to annoying symptoms. This type of infection is experienced by 40-75% of women and is usually easy to treat however approximately 5% of women experience chronic or recurrent problems which can be frustrating and expensive.
Typical symptoms include vulvar itching, burning, pain and stinging when voided urine touches the genitals. The examining physician may find redness, swelling, fissures and a thick curd like discharge. Even though the findings are usually predictive, it is important to have objective testing since other infections are found 72% of the time.
Testing includes a potassium hydroxide (KOH) prep, gram stain or culture. The KOH prep is done by the doctor on the spot. A sample of the discharge with 1-2 drops of KOH are placed on a slide and examined under a microscope to look for the presence of fungi. The gram stain and culture are sent to the lab. The grams stain results are usually available with 1-2 days while the culture may take several days. The KOH and the gram stain provide quick results allowing for immediate treatment while the culture is much more accurate and may identify cases missed by the other tests.
The culture is especially important in cases of recurrence or chronic infections since it can identify the specific organism involved. Although the majority of infections are due to candida albicans, other types such as candida tropicalis can be the culprit in 35% of the cases. This is important because the response to treatment may be variable and there may be some resistance to commonly used antifungals.
Treatment is usually delivered internally with either a cream or suppository and can be 1, 3 or 7 day therapies. The shorter courses tend to have more concentrated medication with treatment effects lasting several days. This more concentrated form however can lead to genital irritation. The most commonly available medications include clotrimazole, miconazole, butoconazole, tioconazole and terconazole. The first 4 are available over the counter without a prescription. Fluconazole is available for oral use but a prescription is required in many countries.
Candida infections tend to occur more often in the 2nd half of the cycle, in the setting of condom use and in those who have intercourse more than 4 times per month. Other risk factors include young age, recent antibiotic use, and other concurrent infections. It is unclear why some women develop frequent recurrent infections however they have been found to have a higher rate of colonization with candida.
Women with frequent recurrent infections can been given chronic courses of antifungal medication in an attempt to suppress the infections. This can be done with weekly local or oral therapy for 3-6 months. There isnít any clear way of preventing these infections but I have had patients who controlled the problem by limiting their intake of simple carbohydrates.
Even though this problem is the source of great distress, it isnít life threatening and many options exist for managing the infections. The drugs mentioned above are generic names so be aware that many of these are marketed under different brand names and you may have to ask the pharmacist for help when you are making a purchase. It is important seek consultation with a health care provider if you are experiencing problems with recurrence or if you are not responding to the over the counter treatments.
I hope this article has provided you with information that will help you make wise choices, so you may:
Live healthy, live well and live long!