Dear Dr Mitchell,

I am 20-years-old. For the past three to four years I have been having this problem with yeast infections. I have visited doctors and each time I complete the medication the infection returns. Could you please explain what I am doing wrong?
The infection comes with a bad odour; discolouration (yellowish); is foamy and itches sometimes. Doctors have diagnosed it to be mere yeast and mixed yeast and trichomoniasis. It has reached to the point where I'm thinking of committing suicide. Another thing, most times when I have sex I bleed. Most times after sex especially when I have an orgasm I notice a brown discharge. Can you please explain the cause of this?

The problem that you are experiencing with recurrent vaginal infections is something that can definitely be treated and is really not a good enough reason for you to become depressed and suicidal. A yeast infection is a fungal infection which presents with a thick curdy white discharge that itches. It is not sexually transmitted in a lot of cases and can be seen in women who are not sexually active. Bacterial vaginosis and trichomonas vaginalis present with vaginal itching but the difference is that these infections both present with a foul "fishy" odour and the colour of the discharge with bacterial vaginosis is greyish-white while trichomonas vaginalis presents with a greenish-coloured discharge. Both bacterial infections presents with a frothy discharge. The discharge you describe seems to be more in keeping with bacterial vaginosis or trichomonias vaginalis. Trichomonas vaginalis is sexually transmitted and your partner will definitely need treatment to reduce the risk of recurrence.

The fact that you experience bleeding after sexual activity is significant. This is most likely due to a chronic infection of the cervix or possibly pre-cancerous changes or even cancer of the cervix. A pap smear at the time of a physical examination is absolutely important. You should also have a vaginal swab done which should be sent to the lab for culture to rule out Chlamydia and gonorrhoea infection and also confirm the exact cause of your recurrent vaginal infections.

All women who are sexually active should have a pap smear done every year. If you have never been sexually active then the recommendation is to start doing pap smears from age 21. Cervical cancer is common in Jamaica and is preventable. It would be wise to discuss the option of receiving the vaccine GARDASIL with your doctor as this will significantly reduce your risk of developing cervical cancer.
You will need to do a blood glucose and HIV test. The presence of diabetes mellitus and HIV infection may contribute to recurrent infections especially vaginal infections. The fact that you have been having recurrent infections especially trichomonas vaginalis is significant.
This suggests a third party involvement. At age 20, you will only create the set up for contracting other sexually transmitted infections such as HIV, which has no cure.

Chronic vaginal infections may also result in infection of the fallopian tubes and pelvic inflammatory disease (PID) which will eventually result in blocked tubes and infertility, if not treated aggressively. In the long-term you may also have chronic pelvic pain. You need to have a serious talk with your partner and determine the extent of his other sexual relationships. If he is not prepared to be committed and if the problem recurs, you should seriously think about discontinuing the relationship.

The treatment for yeast and all those bacterial infections do work effectively and the frequent recurrence that you experience suggests that you are being repeatedly re-infected. You should also practice safe sex at all times and use a condom. At age 20 you should not be depressed or have suicidal ideas because of a vaginal infection. You have so much to live for and you deserve to be happy, so my advice as a mother is that you should discontinue this relationship and get proper evaluation and treatment.

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

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