What is vaginal yeast infection?
Vaginal yeast infection or candidiasis commonly occurs in sexually active women. Its prevalence in this age group is about 75%. Statistics indicate that 45% women suffer from two or more episodes of vaginal candidiasis during their life and 5% continue to have recurrent infections.
Manifestations of vaginal yeast infection
In more than 90% of the cases, the infection is caused by Candida albicans. The patient develops irritation, itching, discomfort, pain around the vaginal opening. In severe cases, there is pain on passing urine and during sexual intercourse. In majority of these patients who have a normal level of immunity, this infection is mild to moderate and is called uncomplicated candidiasis. The complicated candidiasis is an infection which occurs repeatedly, is associated with diabetes, and has severe manifestations like vulvar redness, swelling, ulceration or infection with non-albicans species of candida. The complicated candidiasis infection is also seen in association with pregnancy and in patients on immunosuppressive treatment, steroids and prolonged use of antibiotics. The recurrent infection presents a challenge for the treating physician. The underlying disease like diabetes should be treated or controlled along with treatment of this superadded infection.
The vaginal pH should be performed. A vaginal pH less than 4.5 corroborates with candidiasis, although an elevated pH does not exclude this diagnosis. A reliable diagnosis requires direct microscopic examination of the infective discharge. In cases of recurrent yeast infection, a culture of the infective material is required, as nonalbicans type of yeast may be grown. Nonalbicans Candida infection has been reported in up to 20% of women with recurrent disease. Another condition to be ruled out in such cases is HIV infection and presence of AIDS.
Treatment for uncomplicated infection
Initial treatment is started with local application of vaginal antifungal agents available as cream or suppository for 3 to 7 days. Some of the common antifungals used locally include miconazole, clotrimazole, butoconazole and nystatin.
Oral medications like fluconazole or itraconazole are given to these patients with severe vaginal candidiasis not responding to the local treatment.
Treatment for complicated infection
For patients with nonalbicans infections, the recommended treatment is a 7- to 14-day course of a nonfluconazole azole (posaconazole, voriconazole). If this treatment fails, then a two week course of boric acid vaginal suppositories are recommended. If not successful, however, the patient should be referred to a specialist for further management. For recurrent disease, the treatment is prolonged and includes 6-month course of nystatin vaginal suppository or twice-weekly boric acid vaginal suppositories.
- Topical or local antifungals can be used during pregnancy but oral forms are not recommended.
- Local applications of these antifungals contain mineral oil base, which may damage the latex condoms. Hence another form of contraception should be used during such treatment.
Patients should be advised to maintain good personal hygiene. They should learn to wash their external genitals daily with warm water and soak it dry with clean towel. This area should be wiped from front to back so as to avoid infection from the peri-anal area. Any perfumed or strong acidic soaps, deodorant and bath gels should not be used over the genitals as this area is very sensitive to chemicals. Vaginal douche should also be avoided. It is better to wear cotton undergarments than synthetic clothes as they are more likely to cause irritation locally. Wet clothes after a swim or exercise should be changed early to keep the genital area clean and dry.
Vaginal yeast infection is a common infection in women. In certain diseases, it becomes recurrent. An excessive vaginal irritation and discharge increases discomfort and affects the quality of life. A medical consult is called for to eradicate this infection at the earliest.