Dear Dr Mitchell,

1. I have been treating a supposed yeast infection for more than a year now, but no treatment has been beneficial. I have taken an ultrasound and nothing irregular has been detected, yet I'm still seeing symptoms of the infection, and at present I am bleeding two to three times each month for 10-14 days. I'm extremely frustrated as I have been to numerous doctors and none seem to be able to help. I'm starting to fear cervical cancer. I'm 20 and have been sexually active for two and a half years.

2. I had a yeast infection a few weeks ago and my doctor says it was caused by oral sex. Can a woman get a yeast infection from oral sex?

3. How do you know if you have a yeast infection?

Yeast infection is a common infection in women. It is caused by a fungus called Candida Albicans. Some women are more prone to developing this fungus than others and sometimes develop this problem several times during the year, sometimes even monthly, usually after the menses.
The use of the oral contraceptive pill or other hormonal contraception sometimes cause frequent attacks. Frequent attacks may also be seen in conditions such as:

1. Diabetes Mellitus
2. Systemic lupus erythematous (SLE)
3. Patient with kidney disease resulting in kidney failure
4. Human immunodeficiency virus infection (HIV)
5. Patient on steroid treatment for medical conditions

Yeast infection tends to thrive or grow in conditions where the acidity of the vagina is altered. It frequently shows up after the menses has stopped. It is not necessarily sexually transmitted and women who are not sexually active may have a yeast infection. If there is recurrent infection however, the male partner needs to be treated. Oral sexual intercourse does not usually result in a yeast infections since the normal immune system will prevent this from occurring. However, if a patient is immunocompromised, as in patients who are HIV positive or on steroids, then this may occur. There are other infections that may present with similar symptoms as a yeast infection. These include bacterial vaginosis and trichomonas infection. A yeast infection usually comes with a thick curdy white discharge that itches.
Bacterial vaginosis or gardenerella usually come with a greyish-white watery discharge that has a "fishy" odour.
Trichomonas infection comes with a greenish colour and frothy, fishy odour discharge. A lot of women assume that all vaginal discharge that itches is a yeast but this is a misconception. Too often, over-the-counter preparations are used for a supposed yeast infection with no relief. This is usually because of a wrong self-diagnosis. The treatment for bacterial vaginosis and trichomonas is completely different from that of a yeast infection, since one is a fungal infection and the others are bacterial infections.

The irregular periods experienced in question one are probably due to the fact that you are not ovulating. In this case the ultrasound will be normal and is not usually helpful. You need to have a hormone profile done. This is not an uncommon problem in young women and teenagers; however, it can be treated satisfactorily. Sexual activity at an early age does put you at risk for cervical cancer; however, the bleeding that you experience is regular and predictable during every 10-14 days and suggests a hormonal imbalance.

You will definitely need a pap smear to rule out abnormalities in the cervix. This is the recommendation for all sexually active females or all women 18 years and older. An HIV test and a blood glucose test should be done, especially since you have been having recurrent vaginal infections. Your partner will also need to be investigated and treated. You should practise hanging your underwear in the sun as this will help to reduce recurrent yeast infections.

Consult your gynaecologist who will advise you further.

Dr. Sharmaine Mitchell is an Obstetrician and Gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.

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