Chronic Candidiasis

Almost all women, at least once in their lives, experience the uncomfortable symptoms of vaginal itching, burning, and discharge. It is common wisdom that these symptoms are diagnostic of a “yeast infection.” However, recent medical studies have shown that the majority of women who have these symptoms do not have a yeast infection. However, if it isn’t a yeast infection, what else might it be? To answer this question we need to discuss the symptoms of itching, burning, and discharge.

You feel terrible itching and burning. It feels like you have a thousand mosquito bites in your vagina. When a mosquito bites you, it injects a chemical called histamine into the bite. Histamine reacts on nearby nerve endings to cause the sensation of itching and burning. But, of course, you didn’t get a thousand mosquito bites in your vagina, so what’s going on? Anything that causes inflammation in the vagina causes your own body to release histamine. This leads to the symptoms of itching and burning.

So what can cause inflammation? Any vaginal infection can cause inflammation. The most common vaginal infection is not yeast; but it is instead an infection caused by bacteria called bacterial vaginosis. In addition, another organism called Trichomonas can also cause vaginal infections. But, infections are also not the only cause of inflammation. Perfumes and dyes in soaps or bubble baths, spermacides or lubricants, laundry detergents and fabric softeners can also cause inflammation, irritation, or allergic reactions that stimulate the release of histamine.  It is very difficult for medically untrained woman to correctly self diagnose the cause of her vaginal itching, burning, and discharge.

The term vaginitis refers to any infection or inflammation in the vagina. Studies have shown that in addition to vulvovaginal candidiasis other common forms of vaginitis are bacterial vaginosis and Trichomonas. Approximately 30 to 35% of all vaginitis is caused by an overgrowth of bacteria in the vagina called bacterial vaginosis, 10% of all vaginitis is caused by Trichomonas, 10% is caused by inflammation due to chemicals or allergic reactions, and 20 to 25% of all vaginitis is caused by yeast infections. Approximately 15 to 20% of all vaginitis is actually a combination of two or more of the other types of vaginitis. As most women are aware of yeast infections, but not aware of bacterial vaginosis and Trichomonas, there is a tendency for women to consider vulvovaginal candidiasis for their vaginal symptoms and not the more common diagnosis of bacterial vaginosis.

This fact was underscored by a study in the Journal of Obstetrics and Gynecology in 2002. In this study ninety-five women were stopped in a pharmacy as they were about to purchase an over-the-counter yeast medication. They were offered the opportunity to go to a doctor’s office and have an accurate diagnosis made at that time. Of those ninety-five women who had self diagnosed a yeast infection only 33% were actually found to have only a yeast infection. The majority of women had either bacterial vaginosis or a mixed infection. Therefore they would not have been treated with the over-the-counter yeast medication that they had planned to purchase. As importantly, women who had been previously been diagnosed with a yeast infection were no more likely to be able to self diagnose a yeast infection than those women who had never been told they had a prior yeast infection.

This study illustrates the fact that the symptoms of vaginitis are non-specific. An examination by a healthcare profession is essential to make the accurate diagnosis. Your doctor cannot make the diagnosis of a yeast infection over the phone. Symptoms of itching, burning, and “cottage cheese-like” discharge do not mean you have a yeast infection. Only a healthcare professional has the diagnostic tools and the experience to make an accurate diagnosis, and this must be done in person. To differentiate among the three most common types of vaginitis, a physical examination should be performed. In addition a microscopic examination of the vaginal secretions and measuring the pH of the vaginal secretions is absolutely essential. Additional tests such as a culture or DNA testing are often necessary to make an accurate diagnosis. 

Treatment

If your healthcare provider does diagnose a true yeast infection, there are many different treatment options for vulvovaginal candidiasis. There are both over-the-counter and prescription topical treatments for vulvovaginal candidiasis. In addition there is an oral medication, fluconazole, approved for the treatment of vulvovaginal yeast infections. The topical treatments come in many forms including vaginal creams, suppositories, and tablets. There are single-dose, three-day, or seven-day treatment regimens available.

When topical treatments they are used after an accurate diagnosis of a yeast infection has been made, they are very effective. However, there are also areas of concern associated with topical treatments. For many topical treatments,

• women are advised not to rely on contraceptive devices that contain latex (condoms, diaphragms) because they contain oils that may weaken latex or rubber.

• Women using these topical products are advised to use sanitary napkins instead of tampons if she is menstruating.

• Topical products tend to be messy and most are recommended for use at bedtime.

• Topical products often contain chemicals that can cause allergic reactions or chemical irritation and therefore can cause a superimposed allergic or chemical vaginitis.

• Lastly if a woman uses one of these topical preparations and did not have a yeast infection and then later presents to her healthcare provider’s office, it is often very difficult to make the correct diagnosis because these creams interfere with diagnosis under a microscope and can actually interfere with vaginal cultures as well.

It is for these reasons that this author generally prefers to use the oral medication fluconazole for yeast infections.

Fluconazole which is sold by Pfizer Pharmaceuticals under the brand name, Diflucan, is a one-tablet treatment for vulvovaginal candidiasis.

• A 150 mg tablet is over 90% effective for the treatment of yeast infections.

Diflucan has proven to be extraordinarily safe to use, and there has never been any evidence of systemic side effects (such as liver toxicity) with a single dose of Diflucan.

• The symptoms of a yeast infection start to disappear within thirty-six hours after taking the Diflucan tablet and should completely resolve within two days.

Diflucan does not interfere with oral contraceptive pills, nor does it interfere with other types of contraception such as condoms or diaphragm use.

• The cost of Diflucan is comparable to the topical preparations. Diflucan can be used in combination with a topical steroid ointment which will very quickly start to treat the inflammation of a yeast infection on the labia such that symptomatic relief from the yeast infection can be achieved within a matter of hours instead of waiting up to thirty-six hours for symptomatic relief.

• Diflucan does not obscure further testing if there is a mixed vaginal infection.

• Diflucan does not have the potential to cause an allergic vaginitis.

In summary when a women encounters itching, burning, and discharge it is very important that she understands that there may be one of several different possible causes of these

symptoms. Therefore, it is essential that she go to a healthcare provider and get an accurate diagnosis before she begins treatment. If she is accurately diagnosed with a yeast infection, then there are many options of treatment including creams, suppositories, and oral Diflucan. All of these treatments are very effective; however, it is in this author’s opinion, that Diflucan has less potential for side effects.

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