Frustrating recurrent infections

Dear Dr Mitchell,

I had a dental procedure done last year and I had to be on one week of antibiotics before and one week after, and ever since then I have been having recurrent yeast infections and bacterial vaginosis. I went to my gynaecologist and she did a vaginal swab which revealed that it was indeed the two that I had. She gave me fluconazole and flagyl. After completing that course I noticed that I was having yeast looking vaginal discharge with itching, so she gave me another round of treatment. It worked for a while and then the symptoms came right back. She checked me for STIs but the culture was negative. I have only been having sex with one person for the past four years, and I use mild soap to wash my underwear, with no fabric softener. I also have been using Vagisil to wash myself to see if that might help. I have started eating more yoghurt and taking oral probiotics to see if that would be helpful, but I was swabbed a few weeks after and the same results surfaced. At one point I thought my boyfriend had something to do with it, but after my last treatment we didn’t have any sexual contact for over three months and it still resurfaced. I am in dire need of your advice as to what else I could take. I was also given oral antibiotics and the antifungal and it still came back.

The problem that you are experiencing with recurrent vaginal yeast and bacterial vaginosis needs to be properly evaluated to determine the underlying trigger factors. Bacterial vaginosis is a common cause of an unusual vaginal discharge. It is not necessarily sexually transmitted but it can increase your risk of getting sexually transmitted infections such as chlamydia and human immunodeficiency virus (HIV). It tends to be associated with a strong, fishy smell especially after sexual intercourse. The discharge tends to be greyish-white, thin and watery. Half of the women with bacterial vaginosis have no symptoms. It does not usually cause any soreness or itching. It can sometimes be confused with trichomoniasis infection. This also causes a fishy odour vaginal discharge; however, the discharge is usually yellow to greenish coloured and causes itching and soreness. Bacterial vaginosis may also co-exist with vaginal candidiasis infection (yeast) and this causes intense vaginal itching and swelling of the vulva and vagina.

Causes of recurrent bacterial vaginosis include the use of perfumed products in and around the vagina, scented body wash, scented panty shields, douching, condom usage, a change in sexual partners, the use of the intrauterine contraceptive device, and tampon usage.

There are simple things that you can do to decrease your risk of recurrent bacterial vaginosis. You should rinse the vaginal area with warm water, avoid douching, wipe from front to back after passing urine or stool, change your panty liners, pads or tampons frequently and avoid scented vaginal soaps, sprays and wipes.

You should also wear breathable underwear by choosing loose fitting, lightweight and breathable natural fabric like cotton. Do not use harsh laundry detergents to wash your underwear as this can cause irritation of the skin around the vagina. Use panty liners during the daytime if there is extreme moisture and change them frequently.

Saliva can also transmit bacteria into the vagina and cause overgrowth of bacteria resulting in a change in the environment and overgrowth of bacterial vaginosis. This can happen with oral sexual activity.

The use of probiotics can help to maintain the vaginal PH, making it mildly acidic and may help to prevent recurrence of bacterial vaginosis. Taking lactobacillus after the use of antibiotics may help to prevent re-infection. Eating yoghurt will help.

Reducing your stress levels by regular exercise and deep breathing exercises may also help to lower your production of stress hormones and reduce the occurrence of bacterial vaginosis.

It is also important to have a healthy immune system to help to fight infections. Diabetes mellitus and HIV can weaken your immune system and cause recurrent infections. You should get a blood sugar and HIV test done.

Bacterial vaginosis can be recurrent even after treatment, so you should be vigilant in improving your personal and vaginal hygiene and also use a condom to reduce your risk of recurrence.

It is also important for your partner to be treated to reduce your risk of recurrent yeast and bacterial vaginosis.

Consult your doctor who will advise your further.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5 or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.