Saturday, August 02, 2014

Yeast Infections

Definition

Candidiasis (also called fungus, a yeast infection or moniliasis) is the most common type of vaginal infection. It is caused by the yeast organism, Candida.

Description

Candidiasis is often hard to get rid of and recurrences are common. Many women with this infection do not notice a discharge, but if present, it is usually described as an odorless, white and "cheesy" discharge.

Candidiasis is caused by a fungus-like yeast. Although it can affect any woman, candidiasis is more frequent among women who are pregnant, diabetic or obese. These conditions can alter the body's metabolic balance and vaginal acidity, and promote the growth of the fungus.

If the physical exam and lab tests reveal the presence of candidiasis, your doctor will prescribe medication to destroy the fungus causing the problem. This may include vaginal suppositories, tablets, cream or gel applications into the vagina. The medication may be somewhat messy and you may need to wear a sanitary napkin during treatment. Your doctor will advise you in detail about what is involved.

In most cases, candidiasis will be cured with treatment. However, the infection resists treatment in some women, especially pregnant and diabetic women, and a cure may take some time. Conditions that spur the growth of candidiasis will also need to be changed in order to get rid of the vaginal infection completely.

Causes

Several factors increase susceptibility to yeast infections, particularly pregnancy, prolonged antibiotic use and perhaps birth control pills (still being debated). During pregnancy, vaginal yeasts increase because of decreased vaginal acidity and a higher output of female hormones (which raise glycogen [carbohydrate] levels) favoring candidal growth. Poor ventilation in the genital area may exacerbate or perpetuate (but not cause) yeast infections.

Tight underwear or jeans may trap the infection against the vulva. Other predisposing factors include: menopausal thinning of the vaginal wall, diabetes, cuts or abrasions in the genital area, poor hygiene (soiled underwear and transfer of fecal yeasts) and douching. Dietary sugar and a defect in milk sugar (lactose) metabolism may predispose some women to yeast infections. For them, eliminating dairy products from the diet and cutting down on sugar may help to curb candidiasis.

While there is no proof that diet alters susceptibility to vaginitis, abnormal carbohydrate metabolism (as in diabetes) can increase the sugar content of vaginal secretions. Since yeasts feed on sugar, conditions that raise vaginal glucose levels could promote their growth.

Symptoms

The main symptom of this type of inflammation is intense itching, burning and redness of the vaginal tissues.

Treatment

In general, local application of antifungal therapy is effective in treating yeast vaginitis. There does, however, seem to be two distinct types of patients with this condition. The most common type of patient has isolated, infrequent vaginal yeast infections that respond readily to topical therapy.

The other type of patient has frequently recurring infections that may become chronic and even intractable. Most providers of women's health care are familiar with this condition of recurrent yeast vaginitis. A large number of antifungal agents are currently available for the treatment of vulvo-vaginal candidiasis.

There are two major classes of modern antifungal agents; the polyenes (nystatin, amphotericin) and the imidazole derivatives. The earlier imidazoles (miconazole and clotrimazole) and the newer imidazoles (butoconazole and ketoconazole) now provide the mainstay of antifungal therapy, although the polyenes may still be employed effectively.

For relief of simple yeast vaginitis, numerous agents in various doses have been successfully employed with success rates that vary from 70 to 95 percent. Nystatin vaginal suppositories can be inserted twice daily for 10 days or twice daily for seven days, followed by once daily for seven days. This has been a widely used regimen for years.

In some situations, a single oral dose of fluconazole (Diflucan) appears to be as effective as a seven-day course of daily topical treatment with clotrimazole for treating vaginal infections. Because this is a convenient and effective treatment, it is being used more frequently, however, it is usually more expensive than topical treatment.

Questions

What treatment do you recommend?

How long will it take for relief of symptoms?

What can be done for immediate relief of itching or discomfort?

If on antibiotics, what can be done to prevent infection?

Are there any measures that can be taken to prevent recurring infections?

Is it better to take an oral medication than to use vaginal creams or suppositories?

Self-Care

Instead of going to their doctors, many women can now go to the drugstore to find relief. The FDA has approved the active ingredient in two of the most commonly prescribed antifungal drugs for nonprescription use: Monistat (miconazole nitrate) and Gyne-Lotrimin (clotrimazole), available on drugstore shelves.

That's good news for women with recurrent yeast infections who must pay for each office visit. For those with a suspected first time infection, however, the label advises a doctor visit for confirmation. Women who are pregnant or think they may be pregnant, as well as women who have had more than four yeast infections in one year's time, are also urged to use the product under a doctor's supervision.

The smartest course is to use non-prescription medication only if you are familiar with yeast infection symptoms from previous attacks. If symptoms do not clear within a week, consult your doctor.

Prevention

There are some things women can do when they have vaginitis or when they want to prevent future attacks:

  • Discontinue use of tampons while under treatment. Since underwear and pantyhose made from synthetic fibers often increase heat and moisture in the vulva area, switch to cotton underwear and pantyhose with cotton crotches. For the same reason, don't wear skintight pants.
  • Avoid sexual intercourse while undergoing treatment. Have your sex partner checked by the doctor if you have repeated infections.
  • Practice good feminine hygiene. Wash the vulva and anal areas with mild soap and water at least once daily and after each bowel movement, if possible. Always wipe from front to back, away from the vagina. The bowels harbor bacteria and fungi that can travel over to the vulva area.
  • Do not douche unless the doctor says to. By disturbing the normal acidity of vaginal secretions, douching may create more problems.
  • Make it a rule that anything that goes into the vagina - pessaries, diaphragms and other contraceptive devices, be scrupulously clean.
  • Take the medication for as long as the doctor prescribes. Some women stop the medication when they feel better, but this is an invitation to recurrent infections.