When a woman develops a white discharge and vaginal itching, her doctor often diagnoses yeast infection. He or she may be wrong because every healthy woman has yeast in her vagina. Cultures of the vagina almost always grow yeast, even in women who have no symptoms at all, so cultures should not be used to diagnose yeast since most healthy women harbor yeast in their vaginas, mouths and intestines. The diagnosis can be made by inserting a cotton swab into the vagina, placing it in a drop of water and examining the fluid for yeast under a microscope.
Yeast infections can occur when a woman takes antibiotics, birth control pills or the anti-estrogen, tamoxifen, or it can be a sign of inability to kill germs as in hepatitis C, HIV, diabetes, and so forth. When yeast causes a rash on the genitals, it often can be traced to a sexual contact (1). When 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 may have one of these types of 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 4 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. Short courses of topical therapy, e.g. 500mg clotrimazole pessaries as a single weekly dose for 6 months or 100mg miconazole pessaries twice weekly for 3 months, followed by once weekly for 3 months may also be used (4).
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. It can be cured when they and their partners take azithromycin (250 mg once a day for 9 days) to kill the mycoplasma. See my report on Mycoplasma and chlamydia
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 recent 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.
4) NC Nwokolo, FC Boag. Chronic vaginal candidiasis - Management in the postmenopausal patient. Drugs & Aging, 2000, Vol 16, Iss 5, pp 335-339.
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