Yeast infections are a common gynecologic problem affecting 75% of women at least once in their lives. 40-50% will experience at least one repeat episode and 5% will develop chronic recurrent vulvovaginal candidiasis (RVVC); (4 or more confirmed episodes in 1 year).
Candida Albicans is the most common yeast. Non-albicans species may be increasing in frequency due to self treatment with short, over the counter (OTC) preparations. Signs and symptoms of yeast infections are: itching, especially worse in the evening, burning, swelling, redness, burning on urination (dysuria), increased urinary frequency, painful intercourse (dyspareunia), and/or white cottage cheese-like discharge with yeast-like or vinegar-like odor. Discharge with a yellow or green color, with a foul odor (fishy) is another problem and should be examined by the physician or nurse practitioner.
Up to 20% of normal women will culture positive for candida, yet have no symptoms. This is NORMAL. Candida lives in the vagina normally until some mechanism triggers its overgrowth:
In normal women without any risk factors, reinfection from an extravaginal source and relapse due to inadequate therapy or an intestinal reservoir may lead to RVVC. Other such sources of candida include oral cavities, rectum, and in the ejaculate of male partners.
Self diagnosis and use of OTC medications assumes that once a woman has been previously diagnosed with this condition, she will then recognize it again on the basis of the symptoms above. Unfortunately, candida-like symptoms may be due to other organisms and therefore, OTC preparations will be ineffective. OR, if the patient has RVVC, imidazols like Monistat may lead to non candida albicans overgrowth and treatment failure due to other candida species requiring a different treatment.
Some studies have shown that in 2/3 cases, woman will misdiagnose RVVC. If the first course of OTC treatment is not effective (and please be sure to finish the ENTIRE course), or if you have 2 or more infections in a short time (few months), please call the office.
We prefer to treat VVC topically first - due to high efficiency (best to treat topical disorders topically) and low incidence of side effects. The most common local adverse reactions are burning, stinging, itching, irritation, and/or pain - symptoms are difficult to distinguish from a yeast infection itself.
Fluconazole 150 mg given orally is an alternative to topical treatment. However, oral antifungals may cause nausea, vomiting, abdominal pain, and/or diarrhea in 5% of patients. Other medications may be affected adversely while on fluconazole:
Ask your physician if you are a candidate for oral treatment and be sure to mention if you are on other medications. Some patients may benefit from low dose oral antifungal powders dissolved in water to prevent cyclic yeast infections (i.e. prior to menses). Ask your physician or practitioner. The mechanism by which this works is through eradication of intestinal reservoirs of candida.
BORIC ACID--an old remedy with a great success!! Your vagina is generally a "self-cleaning oven" due to the presence of good bacteria called lactobacillus. Yogurt with live cultures of this organism is a great nutritional addition to your diet. Boric acid will help to maintain the proper pH balance of the vagina. Often this balance is disturbed by medications especially antibiotics and other factors.
Capsules of boric acid 300 mg can be inserted into the vagina daily and will re-acidify the vagina allowing the "good" lactobacillus to colonize and help prevent further yeast infections. You will need a prescription for this. In the past, it could be bought in a bottle and used as a douche.
739 Irving Avenue - Suite 530 Syracuse, NY 13210 Tel: 315-478-1158 - Fax: 315-478-3014
site developed by laurieferger.com