Recurring yeast infections

Monday, January 04, 2010

Dear Dr Mitchell,

I am having a serious problem with yeast infections. Can a woman ever get rid of this infection? I had the infection before because I was taking antibiotics. I got rid of it, however, I had to take antibiotics earlier this year and the infection resurfaced again. I have been to my doctor on numerous occasions and nothing seems to be working. The last time he prescribed a number of medications over a three-month period. I am yet to see the results. I must say that it is not as bad as before but there is some discharge. Please help me.

Yeast infection (vaginal candidiasis) is a very common complaint in women. It is due to a fungus and tends be recurrent in the following conditions:

*Diabetes mellitus

*Systemic Lupus Erythematosus (SLE) or other similar disorders where steroids are used for treatment

*Human Immunodeficiency Virus (HIV) positive women

*Antibiotic usage

*Pregnancy

*The use of combined oral contraceptive pills.

Candidiasis usually presents with a thick, creamy, white discharge that tends to cause itching of the vagina, vulva and sometimes groin regions. Yeast infections do not usually cause an odour and itching is the main complaint. Bacterial vaginosis and trichomonas vaginitis also cause vaginal itching and can sometimes be confused with a yeast infection. The difference is that both of these infections cause a fishy, pungent odour.

The trichomonas infection cause a greenish-yellow, frothy vaginal discharge while bacterial vaginosis is associated with a greyish-white, frothy, watery discharge. Trichomonas vaginitis is definitely sexually transmitted while candidiasis and bacterial vaginosis are not necessarily so. Sometimes vaginal itching can be misdiagnosed as candidiasis and the actual problem is bacterial vaginosis or trichomonas infection.

The treatment is entirely different and unless properly treated the problem will not resolve. If trichomonas vaginitis is the cause of the problem then one has to conclude that there is a third-party involvement and despite treatment of the patient and her spouse there will be recurrence. Bacterial vaginosis may also be recurrent if there is a third-party involvement and so this has to be dealt with.

Yeast infection is usually treated with antifungals which may be given in the form of tablets by mouth, vaginal pessaries, creams or gel preparation. It is always a good idea to get coverage for bacterial vaginosis in a situation where there is recurrence. Bacterial vaginosis and trichomonas infection are treated with Metronidazole and this may be in the form of tablets by mouth, vaginal pessaries or gel preparation.

Your partner should also be treated to reduce the risk of re-infections. Men tend not to show any signs of an infection even though the bacteria or fungus is present and so treatment is necessary despite the lack of symptoms.

You can reduce your risk of recurrent yeast infection by ensuring that your underwear gets adequate sunlight – avoid hanging them in shaded areas in the bathroom. The use of gentian violet to paint the inside of the vagina can sometimes help in resistant cases.

You need to be tested for diabetes mellitus and HIV. If you are immunocompromised in any way this can lead to recurrent infections as well.

Your partner should also have these tests done too.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; mail c/o Jamaica Observer, 40-421/2 Beechwood Ave, Kingston 5; or fax to 968-2025. See responses to your questions in All Woman. We regret we cannot provide personal responses.

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Recurring yeast infections