When a woman develops a white discharge and vaginal itching, her doctor often diagnoses yeast infection, even though he may be wrong because every healthy woman has yeast in her vagina and cultures of the vagina almost always grow yeast, even in women who have no symptoms at all. A doctor diagnoses yeast by inserting a cotton swab into the vagina, placing it in a drop of water and examining the fluid for yeast under a microscope. Cultures should not be used to diagnose yeast as most healthy women harbor yeast in their vaginas, mouths and intestines.
Yeast infections often follow taking antibiotics or birth control pills, but when yeast cause a rash on the genitals, it often is acquired through heterosexual contact or it can be caused by immune defects associated with diseases such as diabetes or HIV. When normal healthy people develop rashes caused by yeast, doctors should look for a cause. Genital infections caused by yeast are often associated with a special type of yeast that is able to break though the skin to cause a red, itchy rash. Men and women with genital rashes caused by yeast either have an immune defect such as diabetes or they have a special yeast that can be acquired through sexual contact.
Women who have documented yeast infections and a rash from it can be cured when they and their partners take ketoconazole, 400mg daily for 14 days, or fluconazole,150 mg/day for four days. Women who keep on getting documented yeast infections may need to take itraconazole 50 to 100mg daily or fluconazole 100mg weekly or 150mg monthly. However, the FDA reports that ketoconazole can cause liver damage. Short courses of topical therapy, e.g. 500mg clotrimazole pessaries as a single weekly dose for six months or 100mg miconazole pessaries twice weekly for 3 months, followed by once weekly for 3 months may also be used.
Since yeast is a normal inhabitant in the vagina, it is often diagnosed as the cause of vaginal itching when it is only an innocent bystander. When a physician takes cultures for many different types of infections and finds only a yeast, he usually prescribes suppositories (over-the-counter clotrimazole vaginal suppository, once a day for three days) to kill yeast and the patient feels better for a week or so because the suppository lubricates the irritated area. Then the itching returns because these women often are infected with mycoplasma/ which is extraordinarily difficult to find on culture/ and can be cured when they and their partners take azithromycin (250 mg once a day for 9 days) to kill the mycoplasma. If a woman really has a vaginal yeast infection, she usually clears up with a pill called fluconazole (150 mg/day for 4 days).
A study from the University of Leeds showed that women who get yeast infections over and over, have the same type of yeast that recurs; it is not a new infection. This means that women with recurrent yeast infections and their partners should be treated for several weeks with oral drugs to kill yeast such a Diflucan, and not just with vaginal suppositories (4).
1) J Warszawski, L Meyer, N Bajos. Is genital mycosis associated with HIV risk behaviors among heterosexuals? American Journal of Public Health 86: 8 Part 1(AUG 1996):1108-1111.
2) One paper recommends a vaginal suppository containing metronidazole and miconazole, twice a day for two weeks, to kill gardnerella, Trichomonas and yeast. S Kukner, T Ergin, N Cicek, M Ugur, H Yesilyurt, O Gokmen. Treatment of vaginitis. International Journal of Gynecology & Obstetrics 52: 1(JAN 1996):43-47. Metronidazole 500 mg and miconazole nitrate 100 mg (Neo-Penotran(R), Embil Pharmacy Company, Istanbul, Turkey) insert twice daily for 14 days.
3) NC Nwokolo, FC Boag. Chronic vaginal candidiasis - Management in the postmenopausal patient. Drugs & Aging, 2000, Vol 16, Iss 5, pp 335-339.
4) An investigation into the pathogenesis of vulvo-vaginal candidosis. Sexually Transmitted Infections, 2001, Vol 77, Iss 3, pp 179-183. SS ElDin, MT Reynolds, HR Ashbee, RC Barton, EGV Evans.
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