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Vaginal Yeast Infection

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Iqra Mazhar

Overview

Vaginal yeast infection is an infection caused by a type of fungus called Candida albicans. It is also referred to as vaginal candidiasis, vulvovaginal candidiasis, or candidal vaginitis. 
&nbsp;

Candida is a part of the body&rsquo;s natural flora, including the mouth, throat, gut, and vagina. However, sometimes, vaginal conditions can change to favor Candida growth, resulting in a vaginal yeast infection. Certain factors such as medications, hormones, and immune system dysfunction can increase the chances of infection. 
&nbsp;

Although it is not a sexually transmitted disease, sexual contact can spread it. Moreover, women who are not sexually active may also acquire it. After bacterial vaginal infections, vaginal candidiasis is the second most common type of vaginal infection in the US<a href="#accordion">[1]</a>. Annually, there are 1.4 million estimated outpatient visits for vaginal candidiasis<a href="#accordion">[1]</a>. Approximately, 3 out of 4 women experience a yeast infection in their lifetime<a href="#accordion">[2]</a>. 
&nbsp;

Signs and Symptoms

Symptoms of a yeast infection include:

<ul>
	<li>Soreness, itching or burning of the vagina or vulva (tissue surrounding the vagina)</li>
	<li>Rash</li>
	<li>Watery or thick, white, chunky discharge that resembles cottage cheese. The discharge is odourless</li>
	<li>Vaginal burning during urination or intercourse</li>
	<li>White coating on the vaginal lining</li>
	<li>Symptoms may worsen before the start of a&nbsp; period 
	&nbsp;</li>
</ul>

Note: Visit a doctor if you face any of these symptoms so that an accurate diagnosis is reached. Some symptoms overlap with certain sexually transmitted infections (STIs) and bacterial vaginosis, so it is essential to get a medical expert&#39;s opinion<a href="#accordion">[3][4]</a>. 
&nbsp;

Causes

Majority of the vaginal yeast infections, 85-90% of cases, are brought on by Candida albicans4. While C. glabrata or C. parapsilosis are responsible for 5&ndash;10% of cases<a href="#accordion">[4]</a>. C.albicans is naturally present in the vaginal area, and the bacterium lactobacillus keeps its growth in check by creating an acidic environment. If there is a decrease in the number of lactobacilli, then candida can overgrow. The following factors cause yeast infection: 
&nbsp;

<ul>
	<li>Antibiotics: These reduce the number of lactobacillus in the vagina</li>
	<li>Uncontrolled Diabetes: Increased sugar in the vaginal mucus membranes can create a favourable environment for yeast to grow.</li>
	<li>Low Immunity: Being HIV positive or having other immune system disorders can reduce immunity in turn causing the yeast to grow uncontrollably.</li>
	<li>Hormonal Disbalance: Changes in the hormones during pregnancy, breastfeeding, <a href="https://merisehat.pk/disease/menopause">menopause</a>, stress or when taking birth control pills, can change the vaginal balance.</li>
	<li>Sex: Yeast infection can be passed through sex even though it isn&rsquo;t considered to be a sexually transmitted disease.</li>
	<li>Vaginal Sprays Or Douches: This involves the use of fluids to wash out the inside of the vagina. This isn&rsquo;t recommended as it can wash out the good bacteria from the vagina and throw off the natural acidity that helps fight infections. 
	&nbsp;</li>
</ul>

Diagnosis

To make an accurate diagnosis, the doctor will ask about your medical history including any STIs or previous yeast infections. The next step is a pelvic exam which can show<a href="#accordion">[3][6]</a>:

<ul>
	<li>White, dry spots on the vaginal wall</li>
	<li>Redness or swelling of the skin of the vulva, in the vagina or on the cervix.</li>
	<li>Cracks in the vulva skin 
	&nbsp;</li>
</ul>

Vaginal discharge is taken in a small amount and examined under the microscope. This is called a vaginal wet mount test. The sample is assessed for the presence of white blood cells, bacteria, yeast, parasites, or other signs of infections. During the wet mount test, a KOH test can also be done on the sample. This involves mixing a few drops of potassium hydroxide (KOH) with the sample. All the bacteria in the sample are killed and only the yeast is left behind, confirming the diagnosis. However, in the case of bacterial vaginosis, a strong fishy odour may be released by adding the KOH. 
&nbsp;

Samples may also be sent for culture, especially if:

<ul>
	<li>The infection does not get cured with treatment</li>
	<li>The infection recurs</li>
</ul>

However, a positive fungal culture does not always signify that the symptoms are due to Candida. 
&nbsp;

Note: If you have a recurring yeast infection, or have more severe symptoms, it may have an underlying cause like compromised immunity or certain risk factors. In such a case, your doctor will write more tests and have your partner tested too. 
&nbsp;

Self-Diagnosis

Women experiencing vulvar itching or unusual discharge often treat themselves with over-the-counter medication assuming they have a yeast infection. However, as per one study, only 11% of women correctly identify their illness<a href="#accordion">[11]</a>. While women with a history of yeast infections typically have a better accuracy (35%)<a href="#accordion">[11]</a>. 
&nbsp;

Self-diagnosis and treatment can:

<ul>
	<li>Waste money and time</li>
	<li>Make you feel more irritated and itchy</li>
</ul>

This is why it is essential to have a doctor or nurse confirm your infection before starting treatment. 
&nbsp;

Treatment

The doctor will prescribe you medication according to the severity of your symptoms<a href="#accordion">[7]</a>. 
&nbsp;

<h5>Simple Infections</h5>

For a simple yeast infection, the doctor usually prescribes a 1-6 days dose of an antifungal cream, ointment, suppository or tablet. Some common medications are:

<ul>
	<li>Butoconazole</li>
	<li>Clotrimazole</li>
	<li>Miconazole</li>
	<li>Terconazole</li>
	<li>Fluconazole</li>
</ul>

Follow up with your doctor to make sure your treatment is effective, and if your symptoms return within 2 months then a follow-up visit should be scheduled. 
&nbsp;

<h5>Complicated Infections</h5>

Your yeast infection is severe if you<a href="#accordion">[2]</a>:

<ul>
	<li>Have severe swelling, itching or redness that leads to tears or sores in your vaginal tissue.</li>
	<li>Have had more than 4 yeast infections in a year</li>
	<li>Are pregnant</li>
	<li>Have uncontrolled <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes</a></li>
	<li>Have a weak immune system</li>
	<li>Have <a href="https://merisehat.pk/disease/hiv-61">HIV</a> 
	&nbsp;</li>
</ul>

In this case, the treatment can include:

<ul>
	<li>7-14 days long treatment with a vaginal cream, suppository, ointment, or tablet.</li>
	<li>2-3 doses of oral fluconazole</li>
	<li>Topical steroids to help ease symptoms while antifungal medication continues 
	&nbsp;</li>
</ul>

Maintenance medications can include weekly doses of oral fluconazole for 6 months or weekly vaginal clotrimazole treatment. 
&nbsp;

<h5>Treatment During Pregnancy</h5>

Only vaginal creams and suppositories are prescribed during pregnancy<a href="#accordion">[8]</a>. Diflucan, an oral drug that comes in a single dose, has not been shown to be safe for use during pregnancy or breastfeeding. According to the US Food and Drug Administration (FDA), oral fluconazole use during the first trimester can result in birth abnormalities<a href="#accordion">[12]</a>. Moreover, a 2016 study found a connection between using oral fluconazole while pregnant and a higher risk of miscarriage<a href="#accordion">[13]</a>.

It is best to speak with your doctor or pharmacist to determine which vaginal creams and suppositories are safe to use during pregnancy as not all of them are. Yeast infections can spread to your baby&#39;s mouth during delivery if they are not addressed. This is called thrush and can be treated with Nystatin.

During pregnancy, the infection can take 10&ndash;14 days to fully disappear. Once the infection clears and all the sores have healed, it may be beneficial to apply a starch-free drying powder to prevent any recurrence. 
&nbsp;

Note: Avoid sexual intercourse until you&#39;ve finished treatment as it can aggravate inflammation, and some antifungal drugs can erode the condom and diaphragm materials. 
&nbsp;

Vaginal candidiasis will probably worsen if neglected, resulting in itching, redness, and inflammation in the region around your vagina. If the inflamed region cracks or if persistent scratching leaves open or raw areas, this can cause a skin infection. 
&nbsp;

Uncommon complications of an untreated yeast infection include:

<ul>
	<li>Exhaustion</li>
	<li>Oral thrush</li>
	<li>Stomach issues 
	&nbsp;</li>
</ul>

If the yeast infection affects other parts of the body such as the heart, blood, brain, and eyes, it can result in invasive candidiasis. Candidemia is one of the most common types of invasive candidiasis in the United States. If not treated swiftly, invasive candidiasis can lead to serious health complications<a href="#accordion">[9]</a>. 
&nbsp;

Factors increasing your risk of developing a yeast infection are as follows<a href="#accordion">[10]</a>:

<ul>
	<li>Antibiotics</li>
	<li>Birth control</li>
	<li>Steroids</li>
	<li>Pregnancy</li>
	<li>Weak immune system</li>
	<li>Uncontrolled diabetes</li>
	<li>Sitting in a wet bathing suit</li>
	<li>Not changing out of sweaty clothes</li>
	<li>Wearing scented tampons or using vaginal deodorant</li>
	<li>Overwashing the vagina 
	&nbsp;</li>
</ul>

There is no guaranteed way to prevent a candida infection, but certain measures can reduce the risk<a href="#accordion">[2][6]</a>: 
&nbsp;

<ul>
	<li>Avoid douching and using female hygiene products as the vagina is self-cleaning and does not require scented products to be washed. Only use warm water to wash the outside of your vagina while showering as even mild soaps can cause itching and dryness.</li>
	<li>Avoid vaginal deodorants or scented pads or tampons</li>
	<li>Wear cotton underwear or underwear made from any other natural fibres, and change into a fresh pair daily. Discard your underwear after 6-12 months of use. Moreover, they should be stored in a clean place which is not damp.</li>
	<li>Wear loose-fitting pants</li>
	<li>Wash your underwear with warm water and dry it under the sun or iron to kill germs.</li>
	<li>Eat a healthy diet and include yoghurt in your daily meals</li>
	<li>Change out of wet clothes promptly</li>
	<li>Avoid hot tubs and hot baths</li>
	<li>Use condoms to prevent catching or spreading the yeast infection</li>
	<li>Keep your blood sugar levels under control if you are diabetic 
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Vaginal yeast infection, also known as candidiasis, is an infection caused by a type of fungus called Candida albicans.</li>
	<li>Signs and symptoms include vaginal itching, burning, watery or bulky vaginal discharge, white coating on the vaginal walls, and rash.</li>
	<li>Causes of a yeast infection may be low immunity, medications, uncontrolled diabetes, hormonal imbalance, sexual intercourse and vaginal douches.</li>
	<li>Diagnosis is done by taking history, doing a pelvic exam, and a vaginal wet mount test.</li>
	<li>Treatment involves vaginal antifungal cream, tablet, suppository, or ointment.</li>
	<li>It is best to avoid sex until you&#39;ve finished treatment as it can aggravate inflammation, and some antifungal drugs can erode the condom and diaphragm materials. 
	&nbsp;</li>
</ul>

[1] Vaginal candidiasis. Centers for Disease Control and Prevention.

[2] Yeast infections: Causes, symptoms, and treatment. Medical News Today.

[3] NCBI Bookshelf

[4] Vaginal yeast infections. Vaginal yeast infections | Office on Women's Health.

[5] Hetal B Gor MD. Vaginitis. Practice Essentials, Pathophysiology, Etiology.

[6] Vaginal yeast infection. Mount Sinai Health System.

[7] Cherney K. Vaginal yeast infection symptoms, causes, treatment, and more. Healthline

[8] Editor. Yeast infections during pregnancy. American Pregnancy Association.

[9] Frothingham S. Untreated yeast infection: Why it should be diagnosed and treated. Healthline

[10] Vaginal yeast infection: Causes, symptoms & treatment. Cleveland Clinic.

[11] Vaginal Yeast Infection. UpToDate.

[12] Center for Drug Evaluation and Research. Use of long-term, high-dose diflucan during pregnancy. U.S. Food and Drug Administration.

[13] Mølgaard-Nielsen D, Svanström H, Melbye M, Hviid A, Pasternak B. Association Between Use of Oral Fluconazole During Pregnancy and Risk of Spontaneous Abortion and Stillbirth. JAMA. 2016;315(1):58–67. doi:10.1001/jama.2015.17844