Vaginal Yeast Infection

Picture of Women with Yeast Infection Disease

A vaginal yeast infection, also known as vaginal candidiasis, genital candidiasis, or vulvovaginal candidiasis (VVC), is an infection involving a type of fungus, or yeast. The fungus most commonly associated with vaginal yeast infection is called Candida albicans, which account for up to 92% of all cases, with the remainder due to other species of Candida.

These fungi can be found all over the body and are normally present in warm and moist areas of the body. Studies have shown that up to 20% to 50% of all women normally carry yeast in the vagina without the presence of symptoms. When C albicans in the vagina multiply to the point of infection, this infection can cause vaginal inflammation, irritation, odor, discharge, and itching.

Certain types of bacteria that live naturally in the vagina usually keep C albicans from growing out of control. If the balance of these microorganisms is upset, C albicans may grow uncontrollably and lead to symptoms. The use of certain medications including antibiotics, changes in hormone levels, or certain diseases are examples of factors that can allow a vaginal yeast infection to develop.

Vaginal yeast infections are extremely common. About 75% of all women develop a yeast infection at some point during their lives.

A vaginal yeast infection is not considered a sexually-transmitted infection (STD), but 12% to 15% of men develop symptoms such as itching and penile rash following sexual contact with an infected partner.

Under normal circumstances, a vaginal yeast infection is not serious and can be treated with medications. However, a vaginal yeast infection can be a sign of an underlying, more serious condition or can lead to serious complications, especially if left untreated.

• Many women who think they have a vaginal yeast infection actually have other types of vaginal infections. When these women attempt to treat their condition with over-the-counter medications intended to treat yeast infections, the symptoms do not improve. This may cause the infection to worsen. A study performed by the American Social Health Association found that 70% of women used over-the-counter medications designed to treat yeast infections before calling their doctor. Studies have shown that when women self-diagnose a vaginal yeast infection, in many cases, the symptoms are related to other conditions, such as bacterial vaginosis, which is a bacterial infection. Other causes of symptoms similar to those of a vaginal yeast infection include local irritation (for example, from intercourse or tampons); allergic reaction; or chemical irritation from soap, perfumes, deodorants, or powders.
• Recurring yeast infections may be a sign of a serious disease such as diabetes, leukemia, or AIDS.
• In very rare cases, a yeast infection can lead to systemic Candidal disease, which is fatal in 75% of people who develop this major complication. This occurs when the infection spreads throughout the body via the bloodstream. Women with weakened immune systems are most susceptible to this type of complication.

The following are symptoms associated with vaginal yeast infections:

• irritated vagina and vaginal area,
• vaginal discharge (typically white-gray and thick, with a consistency resembling cottage cheese),
• intense itching of the genitals,
• painful or burning urination, or
• painful intercourse.

The vagina is an environment that maintains its own balance of microorganisms. When this balance is disrupted, such as when the fungus Candida albicans is allowed to multiply unchecked, a vaginal yeast infection can result. The following are examples of factors that can disrupt the natural balance of microorganisms that live in the vagina:

• Antibiotic use: Antibiotics can destroy bacteria that protect the vagina or alter the balance of bacteria that are normally present. A vaginal yeast infection may develop during or after the use of antibiotics taken to treat other conditions such as strep throat.
• Steroid use
• Diabetes: This disease can lower the glycogen stored in certain vaginal cells. Diabetes may also raise the sugar content (and pH) of the vagina, which increases the risk of developing a vaginal yeast infection.
• Factors that can cause a weakened immune system (for example, HIV/AIDS, steroid use, pregnancy, cancer chemotherapy, or other drugs that weaken the immune system)
• Use of douches or feminine hygiene sprays
• Scratches or wounds in the vagina (for example, caused during insertion of tampons or other objects).
• Underwear that is tight or made of a material other than cotton (this can increase temperature, moisture, and local irritation),
• Hormonal changes:
  • ovulation
  • menopause
  • pregnancy
  • birth control pills
  • hormone therapy

Typically, a vaginal yeast infection is not a life-threatening condition. However, a woman with symptoms of a vaginal yeast infection should see her doctor to rule out other, more serious infections or diseases that may cause or be mistaken for a yeast infection. Anyone with a weakened immune system should contact a doctor upon experiencing any new symptoms. Vaginal yeast infections may cause unpleasant itching, but they should not cause pain. Women experiencing pain should contact their doctor.

In addition, a woman with symptoms of a vaginal yeast infection should contact her doctor if she notices the following:

• foul-smelling or yellow vaginal discharge;
• vaginal discharge that lasts for more than a week;
• bloody discharge;
• increased urination;
• stomach or back pain that accompanies vaginal discharge;
• vomiting;
• fever;
• if symptoms diminish but return within two months; or
• if symptoms are not fully relieved with therapy.

To help determine the cause of vaginal infection or irritation, the doctor usually asks the woman about her symptoms and performs a physical and pelvic examination. The doctor usually also tests the woman's urine and samples of vaginal discharge. Before the exam, sexual intercourse and douching should be avoided for 1-2 days if possible to avoid complicating the diagnosis.

The doctor may also ask the following questions:

• When did this condition begin? Has the discharge changed during the condition?
• What does the discharge look like in terms of color and consistency? Does it have an odor?
• Do you have pain, itching, or burning?
• Does your sexual partner, if you have one, have discharge from his penis?
• Do you have many sexual partners?
• Do you use condoms?
• What helps relieve the discharge?
• Do you take frequent baths?
• Have you tried over-the-counter medications?
• Have you used a douche product?
• What other medications do you take?
• Have you changed detergents or soaps recently?
• Do you often wear tight underwear or pants/jeans?
• Have you had similar symptoms in the past?

During the pelvic examination, the doctor inspects the woman's vaginal canal and cervix for discharge, sores, and any local pain or tenderness. The doctor may insert a speculum into the vagina to examine the cervix. This may be uncomfortable because of pressure on the vaginal tissues.

Most Candidal infections can be diagnosed without laboratory tests. The doctor may administer the following diagnostic tests at the time of examination:

• Discharge sample: The doctor may take culture swabs of any vaginal discharge to determine if the infection is fungal (yeast), protozoan (trichomoniasis), or bacterial (bacterial vaginosis). The doctor may also view a discharge sample under a microscope to look for organisms that cause vaginal yeast infections. Examination of the discharge under a microscope is the simplest and least costly method used for diagnosis of yeast infection, but this test may be negative in up to 50% of women who have a yeast infection.
• Pap test: In some cases, the doctor may administer a Pap test to rule out the possibility of cervical dysplasia or cancer. The test is then sent to a laboratory, and results typically take one week.
• Colposcopy: The doctor may recommend a colposcopy or biopsy if the woman's cervix appears abnormal. Colposcopy involves a lighted microscope to examine the surface of the cervix. A biopsy involves taking a tissue sample for testing.
• DNA tests: The doctor may use special DNA tests to detect yeast or other organisms in the discharge.

Although most vaginal yeast infections can be treated with over-the-counter medications, a woman should confirm the diagnosis with her doctor to ensure proper treatment. Other conditions may produce symptoms that are similar to those of a vaginal yeast infection, and some yeast infections may have a more serious disease as an underlying cause.

Women who have vaginal yeast infections that recur should seek professional medical help. Recurrent vulvovaginal candidiasis (VVC) is a condition defined as 4 or more proven episodes of vaginal yeast infections per year.

Both oral and topical (applied locally) medications are considered to be equally effective in uncomplicated infections (in women who have normal immune systems, who are not pregnant, and who do not have recurrent or severe infections). Oral medications may take slightly longer for symptom relief than topical preparations, but cure rates with both types of products are similar for uncomplicated infections.

Fluconazole (Diflucan) is the most commonly used oral medication for yeast infections. It may produce side effects such as nausea, headache, and abdominal pain. It is usually given in one dose of 150 mg.

Medications are also available in the form of vaginal tablets or cream applicators. These medications include the following:

• miconazole (M-Zole Dual Pack, Micon 7, Monistat 3, Monistat 5, Monistat 7)
• tioconazole (Monistat-1, Vagistat-1)
• butoconazole (Gynazole 1)
• clotrimazole (Mycelex-G, Femcare, Gyne-Lotrimin) (Reported cure rate of about 85% to 90%)
• nystatin (Mycostatin) (Reported cure rate of about 75% to 80%)
• terconazole (Terazol 3, Terazol 7)

In some cases, a single dose of medication has been shown to clear up yeast infections. In other cases, a longer period of medication (three days or seven days) might be prescribed.

In women who have weakened immune systems, more than one dose of oral medications may be prescribed. In these women, a longer course of topical medications (seven to 14 days) is also recommended.

For recurrent infection (more than four episodes per year), oral fluconazole and itraconazole or vaginal clotrimazole might be needed for 6 months. Oral medications are typically recommended if the symptoms are severe. In pregnant women, a longer course of treatment may be needed. Women should consult with their doctor before treatment. Women with an allergy to any ingredients contained within these products should not take them.

For confirmed vaginal yeast infections, over-the-counter medications are available that are usually effective in treating them. The cure rates associated with nonprescription drugs are about 75% to 90%. However, women who do not have a vaginal yeast infection account for two-thirds of all yeast-infection remedies purchased in stores. By using these medications, these women may increase their likelihood of developing a yeast infection that is resistant to future treatment.

Medications to treat vaginal yeast infections come in a variety of forms, including oral medications, vaginal suppositories, and creams. Suppositories are inserted into the vagina. Cream medications are massaged into the vagina and surrounding tissues. Most Candidal infections that are treated at home with over-the-counter or prescription medications clear within a week. People with a weakened immune system should consult their doctor before attempting home-care medications or remedies, as prolonged treatment times may be recommended.

Women who experience increased irritation should immediately discontinue the medication. Pregnant women should consult their doctor before using any of these medications. Women whose symptoms last more than one week after treatment should consult their doctor to treat severe infection or rule out other types of infections or underlying causes.

The following are common home-care techniques, although scientific studies have not proven their effectiveness:

• Vinegar douches: Many women douche following menstrual periods or intercourse. However, doctors discourage such routine cleaning. The vagina is naturally designed to clean itself, and douching may remove healthy bacteria that line the vagina. Attempting to treat an abnormal vaginal discharge by douching may worsen the condition.
• Eating yogurt that contains live acidophilus cultures (or eating acidophilus capsules): Yogurt acts as a medium for certain good bacteria to thrive. Despite popular belief, studies about the benefits of eating yogurt with lactobacillus acidophilus cultures as a way to prevent yeast infection have yielded conflicting results. The scientific benefit of consuming yogurt cultures has not yet been proven.
• Antihistamines or topical anesthetics: These are numbing medications that may mask the symptoms of a vaginal yeast infection. However, they do not treat the underlying cause.

The following are guidelines women should follow to help prevent the likelihood of developing a vaginal yeast infection:

• Keep the vaginal area dry, especially after a shower
• Wipe from front to rear after using the toilet
• Wear loose-fitting cotton underwear, which helps to keep the vaginal area dry and may reduce irritation
• After swimming, change out of a wet bathing suit
• Avoid chemical irritants in deodorant tampons
• Do not use douches or feminine hygiene products, regular bathing is usually adequate to cleanse the vagina

Vaginal yeast infections, under normal circumstances, are usually treatable with over-the-counter medications. However, many women mistake other conditions for vaginal yeast infections, and these other conditions cannot be treated with the same medications that are used for yeast infections.

Women, especially those with immune systems problems, should always consult their doctor upon experiencing symptoms of a yeast infection.