Vaginal yeast infections result when there is an overgrowth of the normal yeast in the vagina. Most cases of yeast infections are caused by the organism Candida albicans, some reports suggest over 90% of yeast infection cases are caused by Candida albicans.
This condition is fairly common, and the Centers for Disease Control and Prevention (CDC) cite nearly 75% of all adult women have had at least one yeast infection in their lifetime. Many women who have had yeast infections typically experience at least two episodes of this condition. Yeast infections are also common during pregnancy. About 5% of women get recurrent vulvovaginal candidiasis, where they experience four or more yeast infections in one year.
What is a Yeast Infection?
Yeast infections are also referred to as genital or vulvovaginal candidiasis, or moniliasis. This condition arises when Candida, microscopic fungus that is commonly found in the body in small amounts, multiply. This imbalance produces symptoms of a yeast infection.
Vaginal yeast infections are a type of vaginitis, or inflammation of the vagina. This condition causes irritation, abnormal discharge, and itchiness of the vagina and the vulva, or tissue at the opening of the vagina.
The immune system usually helps keep yeast levels under control. Patients with weakened immune systems, or those who are taking antibiotics, are at an increased risk of a yeast infection. Other patients who have a higher risk of developing a yeast infection include those who are pregnant, have diabetes, and who are currently using corticosteroid medications.
Women and girls of any age can get a yeast infection, however it is rare before puberty or after menopause.
While the term “yeast infection” typically refers to a vaginal yeast infection, Candida infections can also be found in different parts of the body, as Candida yeast typically live in the mouth, gastrointestinal tract, and vagina. Men with genital candidiasis may develop an itchy rash on the penis. Candidiasis that develops in the mouth or throat is called oropharyngeal candidiasis, or thrush. Invasive candidiasis is an infection of Candida in the bloodstream, which can spread throughout the body.
What Causes a Yeast Infection?
While Candida yeast are always present in the body, lactobacillus bacteria produce acid that prevents overgrowth of yeast in the body. A disruption in the mix of the yeast and bacteria in the body can lead to symptoms of a yeast infection. Such imbalances may be due to:
- Changes in the normal acidity of the vagina
- Changes in hormonal balances
- Antibiotic use
- Poor eating habits, especially consumption of lots of sugary foods
- Lack of sleep
- Uncontrolled or untreated diabetes
- Impaired immune system
- Using oral contraceptives
- Use of cortisone-related medications, such as prednisone
- Utilizing hormone therapy – especially estrogen therapy
- Injury to the inner vagina, such as following chemotherapy
Candida can also be passed from person-to-person through sexual intercourse, including mouth-to-genital contact, however this is not common. A yeast infection is not considered a sexually transmitted infection, and women who are not sexually active can experience this condition.
Signs and Symptoms of a Yeast Infection
Most yeast infections are mild to moderate conditions. Symptoms of a yeast infection include:
- Abnormal vaginal discharge – may be “cottage cheese-like”, thick, odor-free
- Genital itching – in the vagina and the vulva
- Genital burning – often during intercourse or while urinating
- Redness and swelling of the vulva
- Vaginal pain
- Vaginal soreness
- Vaginal rash
Symptoms of a yeast infection are similar to those seen with sexually transmitted infections and bacterial vaginosis. In addition to some of the same symptoms seen in a yeast infection, sexually transmitted infections often cause pain when urinating, as well as painful sexual intercourse. Trichomoniasis may also produce vaginal itching and foul-smelling green frothy discharge, as well as redness and swelling of the labia. Bacterial vaginosis often presents with discharge accompanied by a strong and fishy-smelling odor, as well as pain when urinating. A medical provider can help you determine which condition you have.
Prevention of a Yeast Infection
You can take several steps to reduce your risk of getting a yeast infection. While the following methods may help decrease your risk, they are not guaranteed to completely prevent the onset of a yeast infection:
- Wearing cotton underwear
- Wearing clothes made of natural fibers – cotton, linen, silk
- Changing feminine products frequently
- Maintaining a well-balanced healthy diet
- Wearing loose-fitting pants and skirts, avoiding tight-fitting pants and pantyhose
- Avoiding hot tubs or taking frequent baths in very hot water
- Avoiding sexual intercourse with any female partners exhibiting symptoms of a yeast infection
- Using condoms during sex
- Using antibiotics only as prescribed by a medical provider, avoiding unnecessary antibiotic use
- Immediately changing out of wet clothes – workout clothes, swim suits
- Avoiding douching
- Avoiding using scented feminine products – bubble baths, sprays, tampons, and pads
- Always wiping from front to back when using the bathroom
- If you have diabetes, ensure your blood sugar is under control
Some women, particularly those who experience recurrent yeast infections, have found that taking oral or intravaginal probiotics help prevent frequent infections. Yogurt with live cultures, or lactobacillus acidophilus capsules may help prevent yeast infections.
Treatment of a Yeast Infection
Some cases of yeast infections clear up on their own, usually when menstruation begins. This is because menstrual blood causes the vaginal pH to increase, inhibiting rapid growth of yeast cells.
Treatment for short-term yeast infections can last from one day to seven days. Antifungal medications are commonly used to treat yeast infections, most often antifungal vaginal suppositories or creams.
Mild yeast infections can sometimes be treated with a single dose of oral antifungal medication, such as the antifungal medication fluconazole (Diflucan). Diflucan can also be taken in two single doses, three days apart.
Over-the-counter antifungal vaginal creams or suppositories are available as well. When considering over-the-counter medications, it is important to properly evaluate your symptoms and ensure that your condition is a yeast infection. In fact, 2 out of 3 women who purchase over-the-counter yeast infection medication don’t actually have a yeast infection. Speaking with a doctor or nurse first can help determine the cause of your symptoms, and rule out more serious infections.
Medications that are commonly used to treat yeast infections include “azole” medications:
- Butoconazole (Gynazole-1)
- Clotrimazole (Gyne-Lotrimin)
- Miconazole (Monistat 3)
- Terconazole (Terazol 3)
Common side effects from such medications include mild burning or irritation, especially at the time of application within the vagina. Your doctor may recommend alternative or additional forms of birth control if you are sexually active, as many of the suppositories and creams are oil-based, and have the potential for weakening the efficacy of latex condoms or diaphragms. Additionally, tampons may absorb medications that are applied within the vagina, so it is recommended that women use pads during their periods when on treatment.
Patients with complicated or recurrent yeast infections (four or more within a year) may need a longer course of treatment. Such patients include those who:
- Are pregnant
- Are experiencing severe symptoms
- Have uncontrolled diabetes
- Are HIV positive
- Have weakened immune systems
A medical provider can help patients with complicated or recurrent yeast infections develop a maintenance plan to address ways to decrease incidences of yeast infections. Treatments that are given for more complicated yeast infections include:
- A long-course treatment of azole medications, typically lasting 7-14 days
- Multidose oral medications, such as fluconazole – this treatment should not be given to pregnant women, as it may cause birth defects
- Maintenance medications – this treatment plan is typically started once initial symptoms of a yeast infection clear up, and usually involves a regimen of oral fluconazole or vaginal suppository clotrimazole once a week for 6 months
Some patients have found relief of yeast infection symptoms through probiotic therapy, such as eating yogurt, or applying it vaginally. Although this was shown to be effective in a several small studies, further research is warranted to determine its efficacy.
Other natural or alternative solutions for vaginal yeast infections include the use of tea tree oil cream and garlic vaginal suppositories.
Alternatively, a prescription for vaginal insert boric acid can help treat chronic and less-common strains of yeast infections. Treatment is applied twice daily for two weeks. This treatment is not safe for pregnant women.
Patients with weak immune systems may be more difficult to treat. People who are immunocompromised should consult a medical provider before attempting to treat symptoms of a yeast infection on their own.
When Should I Call a Doctor?
Consider speaking with a medical provider if this is the first time you are experiencing symptoms of a yeast infection, or if you are not sure that your symptoms are those of a yeast infection.
Consult a doctor if over-the-counter treatments are not working, you develop new symptoms, or if your symptoms worsen.
If you experience another yeast infection within two months of treating a separate yeast infection, follow-up with your doctor.
If you are pregnant, seek medical care as soon as possible, so that you can develop a treatment plan that is safe during pregnancy.
If you have a weakened immune system or are immunocompromised, seek medical care for proper treatment.
Emergency Warning Signs
If you are currently experiencing lower abdominal pain and a fever greater than 101 degrees F, in addition to vaginal discharge, this may be a sign of pelvic inflammatory disease, and you should seek medical care immediately.