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Women's Health

Yeast infection that won`t go away?

08/20/2007

Question:

A couple days after I had an annual pap smear, I developed a severe yeast infection. I had never had one or any type of vaginal infection before (I`m 29). I self-medicated with over the counter one-dose medications twice over the course of a couple weeks. I still had symptoms, though I had improved. I went to the gynecologist to make sure I really had a yeast infection. She confirmed it was a yeast infection and prescribed a prescription pill (flucanozole). I took this and seemed better the next day, then got my period the same day. While I had my period, I couldn`t tell if the discharge had stopped but I didn`t have itching/burning. The day after my period stopped I had the same yeast infection symptoms, fairly bad. I went back to the gynecologist and she gave me a prescription for TWO flucanozole pills. I took these over the course of two days (and got sick to my stomach). Now it`s a few days later and I still have the same yeast infection, in fact it`s gotten slightly worse. I`ve had this infection for a month now and have taken 5 different "one-time" treatments, and spent a ton of money on medications and doctor`s visits. Please help!!!

Answer:

By the sounds of it, you are having a yeast infection that is not responding well to the treatments.

Symptoms of a vaginal yeast infection often include:

Vaginal yeast infections are quite common. At least 75% of all women are likely to have at least one yeast infection, and up to 45% have two or more. Proper treatment normally cures up to 90% of vaginal yeast infections within two weeks or less.

Several things can be done to prevent vaginal yeast infections. The external genital area should be clean and dry. Avoid irritating soaps (including bubble baths), vaginal sprays and douches. Change tampons and sanitary napkins frequently. Wear loose cotton (rather than nylon) underwear that doesn't trap moisture.

About 5% of women develop recurrent vulvovaginal candidiasis (RVVC), which is defined as four or more vaginal yeast infections in a one-year period. Although RVVC is more common in women who have diabetes or weakened immune systems, most have no underlying medical illness that would predispose them to recurrent infections. However, to be sure, women who have RVVC should be tested for diabetes and HIV - two conditions that can suppress the immune system and increase the risk of infections. If you have not had these tests done, talk to your doctor about whether he or she would recommend you be tested.

We are still trying to figure out the best way to treat RVVC. Currently, most doctors treat this problem with two weeks of oral medication, followed by up to six months of a lower maintenance dose. As mentioned, sometimes it is useful to obtain cultures to see exactly what type of yeast is present. You might want to call your doctor and ask him/her to call in two weeks of the fluconazole (to be taken once a day).

One article published about three years ago in the GYN literature recommended yogurt orally and vaginally for recurrent chronic yeast infections. Although not yet proven to be effective in large trials, it may be worth trying. Vaginally, the yogurt can be applied to a tampon daily for 2-3 days, sitting in a ½ tub of lukewarm water (no soap) with 8 oz of yogurt in the water daily for 3 days, or by using a warm water douche with 1 tablespoon of yogurt daily for 3 days. Orally, it is 6 to 8 oz of Dannon yogurt twice a day (low calorie if calories are a problem). In terms of other dietary changes, such as the yeast-free diet, your physician is correct in that no studies have documented their efficacy.

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Response by:

W. Fred Miser, MD W. Fred Miser, MD
Associate Professor of Family Medicine
Director of Ohio State Medicine Residency Program
College of Medicine
The Ohio State University