Vaginal Yeast Infection

Vaginal Yeast Infections: An Overview

Vaginal Yeast Infections are mainly caused by a microorganism from the Candida genus known as Candida albicans. It is a yeast or a type of fungus that normally causes infections known as Candidiasis – resulting in Vaginal Candidiasis (the other term for Vaginal Yeast Infections) when it persists in the female genitalia region. Such an infection usually presents as itching or soreness within the genital region, pain during intercourse, discomfort during urination, and an unpleasant or abnormal vaginal discharge. Fortunately, treatment is easily administered through the use of antifungal medicines to effectively control the growth of the microorganism within the area. Diagnosis, however, could prove to be somehow challenging due to the innate presence of Candida sp. in the area despite the absence of manifestations associated with an infection.

Candidiasis or Candida Infections

Candidiasis is an infection caused by a certain type of fungus known as yeast, specifically, the genus known as Candida. This microorganism normally lives all over the body as part of its normal flora, but any changes to the environment which could then promote the growth of fungal microorganisms usually results in its massive reproduction that then ultimately leads to an infection. When candidiasis is observed in the mouth, it is known as oropharyngeal candidiasis, in the esophagus, it is known as esophageal candidiasis, and when it persists in the vagina it is then called vaginal candidiasis, vaginal yeast infection, candida vaginitis, or vulvovaginal candidiasis.

Who should look out for such infections?

According to its epidemiological recurrence, vaginal yeast infections affect 3 out of 4 women at some point within their lifetime. Many individuals could even experience at least 2 episodes due to the innate presence of its causative agent in the body, simply waiting for the right conditions for it to flourish and reproduce.

How is it contracted?

The manifestation of such an infection usually originates within the person itself as candidiasis is usually a result of any changes in the environment that could promote the growth of the microorganism. This includes hormonal changes, instances where the individual is immunocompromised, pregnancy, taking antibiotics, and even having co-morbidities such as diabetes. Do take note, however, that while vaginal yeast infections are not necessarily considered a sexually transmitted disease, there is an increased risk of contracting the condition during the time of your first sexual activity. Studies have also shown that mouth to genital contact may also cause the development of such infection due to the changes brought upon by its contact with the conditions of the vagina.

The following list further describes other conditions that might promote the growth of the microorganism within your body:

• Antibiotic use
  • The growth of yeast thrives when there is an imbalance of bacteria in the body. When a person takes broad-spectrum antibiotics, a large range of bacteria is killed - including the healthy bacteria in the vagina, leading to an imbalance and excess growth of yeast.
• Diabetes
  • For women who have uncontrolled diabetes, the sugar content of the mucous produced within the vagina may possibly cause excess growth of yeast.
• Co-morbidities such as diabetes mellitus that is left untreated
• Excessive douching
• Feminine hygiene products that are doused with perfumes
• Pregnancy
• Topical steroids
• Birth control pills
• Poor or weak immune system
• Opting for skin-tight undergarments and panties
• Lack of sleep
• Hormonal imbalance during each menstrual cycle
• Poor eating habits

Are treatment options available?

Luckily, it is easily treatable for the majority, if not the totality of the population. The treatment regimen usually consists of a course of antifungal medicine that could either be taken orally or applied topically within the vaginal region. The usual medication that it provided is fluconazole, but other medications such as boric acid, nystatin, and flucytosine could also be prescribed depending on the severity of the condition. Do remember to consult your physician before taking any of these medications to prevent wasting your resources and avoid instances where the medication would cause more harm than good for your condition.

Signs, Symptoms, and Manifestations of Vaginal Yeast Infections

Candidiasis infections usually present differently depending on where they are located. With vaginal yeast infections, the most common presentation is extreme itchiness and discomfort around the vagina caused by the persistence of the microorganism within the area. Although such an infection is usually mild and easily treated with a course of antifungal medication, some women have reported experiencing symptoms such as redness, swelling, and the appearance of cracks and broken skin in the wall of the vagina. The following manifestations could also be observed by other people depending on the severity of your condition:

• A burning sensation that is made more prominent during intercourse
• Painful urination
• Redness and swelling around the vulva (thus gaining the name vulvovaginal candidiasis)
• General pain and soreness
• Vaginal rash
• A thick, white, and odor-free vaginal discharge that is described by some as being cottage-cheese like
• Watery vaginal discharge

Symptoms would usually appear around 1 to 3 weeks after contracting the microorganism. However, symptoms would generally vary still depending on the length of time that the infection has persisted and the general severity of your condition. To ensure that your condition is properly examined by your physician, do remember these details for them to make a well-informed prescription that could then effectively treat your condition.

Do take note as well that self-medication could potentially worsen your condition instead of improving it. Other conditions such as bacterial vaginosis or the overgrowth of bacteria within the vagina could also manifest similar signs and symptoms. Accurate testing and diagnosis are necessary to properly conclude the condition that you are experiencing.

Complications and Risks

Complicated Vaginal Yeast Infections

Any disease caused by a microorganism could persist and potentially worsen as it is left untreated. When an infection is allowed to persist, this could produce more severe symptoms that could eventually make it much harder to treat and manage. Vaginal yeast infections are no different from such classification, and it may progress to a more complicated stage when it is not managed properly and correctly.

To determine whether your condition is progressing for the worst, the following criteria may be helpful to assess your current status:

• Severe manifestations are now evident such as excessive redness, swelling around the area, itching that progresses to tissue damage, cracks, and development of sores
• You have 4 or more recurrent yeast infections in the previous year
• Your infection is caused by another type of fungus
• You are currently undergoing pregnancy
• Your diabetes and other co-morbidities are likewise left uncontrolled
• You have a weak immune system due to immunosuppressants or other conditions such as HIV or AIDS

The At-Risk Population

To prevent such development and severe progression from happening, it might be wise to assess whether you are susceptible to the disease and are currently part of the at-risk population. The following are the individuals who are more likely to contract the condition due to their specific circumstances:

• Pregnant women
• People using hormonal contraceptives such as birth control pills
• People with co-morbidities such as diabetes
• People with weak immune systems due to a medication that they are taking or a condition that they currently have as well
• Have taken or are recently taking antibiotics that might suppress the “good bacteria” in the vagina

Preventive Measures

As previously mentioned, tight-fitting garments are commonly attributed as the most common cause of vaginal candidiasis. As such, it might be wise to avoid such clothing that is too tight or opt for undergarments that have a cotton-made crotch area to avoid friction and constant damage to your vaginal tissue.

The following steps may likewise help in preventing the development of the infection or to lower the overall risk of having an environment that is suitable for the excessive proliferation of this microorganism:

1. Avoid excessive douching

Douching or the action of washing the vagina, while it can remove any unpleasant odors and dirt that might be causing you discomfort, greatly damages the normal flora of the genitalia. This normal flora is responsible for keeping the pathogenic bacteria in check – resulting in the proliferation of the infectious microorganisms when it is constantly removed time after time. In a sense, excessive douching removes your line of defense and puts it in a compromised position to even act against pathogenic microbes.

2. Avoid scented or excessively scented female products such as bubble baths, sprays, pads, and tampons

Apart from being pleasantly smelling, the addition of deviant substances in these products would most likely compromise the environment of your vagina. Avoid the excessive use of such products.

3. Change your undergarments and hygiene products often

Much like with any other infection, hygiene is one of the critical factors that sometimes pushes the infection over the edge – causing a full-blown manifestation with evident signs and symptoms. Make sure that you are constantly replacing your undergarments as well as your tampons and pads.

4. Avoid tight-fitting undergarments

Speaking of maintaining the environment of your vagina, wearing tight-fitting undergarments increases the overall temperature of your genitalia and retains moisture within the area. Sufficient hydration combined with a suitable temperature to proliferate in are the exact conditions that you do not want to have in the presence of these microorganisms.

5. Opt for cotton-based underwear

Cotton, unlike other tight-fitting garments, helps in keeping your vaginal area dry on top of it being a poor retainer of heat. As such, it eliminates the conditions that the microbe needs for it to grow – making it suitable to prevent the causative species from proliferating.

6. Do not stay in wet clothes

Similar to what was mentioned previously, moisture is a huge blessing to microorganisms as it encourages their growth given the right conditions. Avoid moisture. Always keep dry

7. When using the bathroom, always wipe from front to back

Due to the proximity of the anus to the vagina in women, infectious microorganisms associated with fecal matter could compromise the conditions within your genitalia and allow the development of various other infections, including candidiasis. Wiping from front to back ensure that fecal matter is not deposited into the sensitive tissues of your vagina.

8. Maintain your blood sugar in its optimal levels if you are diabetic

9. Opt-out from hot tubs and hot baths from time to time

10. Avoid the unnecessary use of antibiotics

Antibiotics sometimes do not discriminate against good bacteria and bad bacteria, especially if their target molecule is likewise found in the cell of a species found in the normal flora. Consuming antibiotics unnecessarily could kill the good bacteria maintaining the pH of your vagina – turning its conditions askew and suitable for the development of an infection. If you are worried about certain symptoms that you might be having, always opt for a consultation before even remotely considering self-medication.

11. Use condoms or generally avoid sex when diagnosed with a yeast infection

This preventive measure is mainly attributed to men as this refers to penile irritation. Although it does not usually happen for men, irritation in males is still possible. Do remember, however, that vaginal yeast infections are still not considered an STD despite this.

Testing and Diagnosis of Vaginal Yeast Infections

Uncomplicated Vulvovaginal Candidiasis

The first criteria that physicians generally look at are the symptomatic manifestations of a patient to determine whether a woman is potentially infected with C. albicans. While this is not necessarily the gold standard when it comes to diagnostic procedures, it is performed to narrow down the causes of the symptoms that the patient is experiencing, much like what is done in any other condition.

With vaginal yeast infections, the main symptoms that would usually qualify for such are external redness of the genitalia, presence of rash, painful sensations within the area, and swelling of the genitals. In addition to that, the inner part may also manifest a slight swelling, fissures, excoriations, and produce a thick vaginal discharge that resembles the texture of cottage cheese according to the Centers for Disease Control and Prevention. While the discharge could also be watery in certain cases, the diagnosis ultimately boils down to more conclusive tests and would require one either way once the other symptoms match the criteria for a possible Candida infection.

When the following signs and symptoms are observed in a patient, the physician now then proceeds to make their diagnosis based on two factors:

1. When a sample is cultured in the laboratory comes back with a positive result for a yeast species, especially if it is specific to Candida sp., then the doctor could then provide the diagnosis that the patient is indeed experiencing a vaginal yeast infection.
   • Culture sampling is usually indicated when the patient tests negative for a wet mount test (gram staining and visualization). However, do take note that a positive lab test for Candida without any symptoms or manifestations is not conclusive evidence of a persisting vaginal yeast infection. The body naturally harbors Candida sp., and this could produce a false positive result especially when the patient is asymptomatic at best.
2. When a sample combined with saline and 10% potassium hydroxide (KOH) is gram stained to determine the classification of the microorganism as well as its anatomical and physiological structure, and the results show evidence of a yeast-like structure complete with budding, presence of hyphae or tendril-like structures, and pseudohyphae, then the physician can likewise conclude it to be a yeast infection
   • The 10% KOH solution is utilized to improve the image produced through the gram staining process by disrupting the cellular materials that would otherwise be an obstruction upon visualization. This procedure is usually indicated for all women who are found to be qualified based on the signs and symptoms that they have experienced, and when the results come back positive, these individuals should be promptly treated to prevent the infection from progressing any further. On the other hand, if the results come back negative, a culture test is then indicated as there might just be a few discrepancies with how the testing was performed or with the sample that was originally procured.

Complicated Vulvovaginal Candidiasis

Complicated forms of VVC or Vulvovaginal Candidiasis are usually caused by an unusual Candida species – causing various other symptoms that should be approached differently as compared to an uncomplicated VVC condition. As such, vaginal cultures are necessary to narrow down the unusual species, considering non-albicans microorganisms through visualization and thorough examination. Next C. albicans, C. glabrata is another microorganism from this genus that causes the same condition and manifestations. The difference with this microorganism, however, is that, unlike C. albicans, it does not form pseudohyphae and its hyphae are likewise not easily recognized when examined under a microscope.

Expectations for the Test

The test would usually comprise of a pelvic exam wherein your physician would conduct an extraction of your vaginal discharge that will then be used for cell culture testing and microscopic examination. Usually, a microscopic examination is preferred as it is fast, secure, and easy to perform. However, when there an insufficient number of cells to generate a positive or negative result, a culture test will then follow. This procedure, on the one hand, would take a few days for it to grow and develop in a specialized lab. Expect a few days to a few weeks of waiting time if your physician opted for a culture test of your sample.

Preparations for and Risks of the Testing Procedure

There are no notable risks for such a procedure as it is a minimally invasive process that only aims to procure a sample of your vaginal discharge. No special precautions and preparations are also necessary for such a test apart from showing up and informing your doctor about everything that they would have to know to make a diagnosis. Be sure to especially tell your physician if you are taking antibiotics as this could cause an overgrowth of yeasts in the body.

General Comparison of Fungal Infection Tests

Test Type	Process	Uses	Speed of Results
KOH Prep	The sample is placed on a slide, then a chemical is added to dissolve the obstructive elements. The technician would then examine the presence of yeast cells and fungal hyphae which are branch-like structures protruding out of a cell.	Used as a primary screening tool as it detects the presence of a fungus but could not necessarily determine the type or species of the fungus.	Immediate
Calcofluor White Stain	A stain is added to your sample that will then glow under UV light. Could provide better visualization of the fungus.	Detects fungi but could not determine the specific species of the fungus.	Immediate
Fungal Cell Culture	Your sample is inoculated into a nutrient media that will then grow more copies of the fungi present in your sample.	The primary tool for fungal infection diagnosis. Grown cultures can be used for other tests such as susceptibility testing.	Weeks

Lab Tests Online. (2021). Fungal Tests. Retrieved from https://labtestsonline.org/tests/fungal-tests

Treatment and Recovery

Uncomplicated Vulvovaginal Candidiasis

Uncomplicated VVCs usually only require short-course topical formulations such as single-dose therapies for a duration of around 1 to 3 days according to the Centers for Disease Control and Prevention. In most cases, the topical application of azole-based medications produces better results than the use of nystatin and it effectively produces negative cultures 80 to 90% of the time following the treatment course. The following list indicates the medications that are usually indicated for uncomplicated VVC:

Over-the-Counter Intravaginal Medications

Drug	Dosage Form	Dose	Application	Duration
Clotrimazole	1% cream	5g	Intravaginal	Daily for 7 to 14 days
	2% cream			Daily for 3 days
Miconazole	2% cream			Daily for 7 days
	4% cream			Daily for 3 days
	Vaginal Suppository	100 mg	Vaginal Suppository	One suppository daily for 7 days
		200 mg		One suppository daily for 3 days
		1200 mg		One suppository for 1 day
Ticonazole	6.5% ointment	5g	Intravaginal	Single Application

Prescription Intravaginal Agents

Drug	Dosage Form	Dose	Application	Duration
Butoconazole	2% cream (single dose bioadhesive product)	5g	Single Application	Single Application
Terconazole	0.4% cream	5g	Intravaginal	Daily for 7 days
	0.8% cream			Daily for 3 days
	Vaginal Suppository		Vaginal Suppository	One suppository daily for 3 days

Precaution: The creams and ointments that are indicated in this list are oil-based and could potentially weaken latex-based condoms. To determine if the condom that will be used during intercourse will be sufficient with such intravaginal medications, consult the condom packaging for further information.

Oral Intravaginal Agents

Follow-Up Procedure after Treatment Regimen

Follow-up consultations are not overly necessary with uncomplicated VVCs. However, if you do observe that your symptoms are worsening or are still recurring even after the course of medication, immediately inform your doctor for them to reassess your therapeutic regimen.

Treatment of Sexual Partners

Considering that VVC is not considered as a sexually transmitted disease on top of studies indicating that Uncomplicated VVCs are not transmitted sexually, there is no need to subject your sexual partner through the same treatment regimen prescribed to you. However, in certain cases such as when your male partner is experiencing balanitis which is characterized by the presence of rash and irritation on the glans of the penis, they may benefit from a topical antifungal application.

Side Effects and Adverse Reactions

The topical agents indicated in this list usually do not cause significant systemic effects that would require precaution and utmost care. However, some common side effects of applying this medication may include a localized burning sensation and irritation if it is not tolerated well.

On the other hand, the oral azole indicated may cause nausea, abdominal pain, and headache as a part of its adverse reaction. It may also elevate your liver enzymes and cause certain interactions when taken alongside other medications. Inform your doctor about any medication, supplements, and vitamins that you are taking to avoid such instances.

Complicated Vulvovaginal Candidiasis

Recurrent VVC

Recurrent VVC is defined as having four or more symptomatic infections within a year, and this usually only affects around 5% of women in the population. This variation is still poorly understood, and its transmission is not yet conclusive despite the studies being performed on this condition. This is usually caused by another species known as C. glabrata as well as other non-albicans Candida species wherein conventional antifungal therapies are not as effective.

Every single infection caused by C. albicans would generally respond well to a short-term oral or topical treatment regimen with azoles. However, considering that this condition is recurrent, physicians recommend a longer-term treatment regimen such as 7 to 14 days of topical therapy coupled with 100+ mg doses, and an oral dose of fluconazole every third day for a total of 3 doses to prevent any recurrence before the maintenance medication is provided.

To prevent the recurrence of your VVC in the long run, oral fluconazole is usually indicated weekly for 6 months. Topical treatment could likewise be included in this regimen if the previous indication is still insufficient to control the infection. A new examination might be necessary if the patient still tests negative even after months of continuous medication.

Severe VVC

With severe VVC, patients are usually observed to be non-responsive or have low response rates to short-course oral and topical medications. As such, physicians would usually prescribe either 7 to 14 days of topical fluconazole, or 150 mg of fluconazole in 2 succeeding oral doses with a 72-hour gap.

Non-albicans VVC

The optimal treatment for such a condition is still unknown since the mechanism of other species is not yet fully understood. With such an unclear diagnosis and prescription guide, physicians would usually opt for a longer therapy that may span from 7 to 14 days with a non-fluconazole azole regimen, topical or oral. In addition to that, 600mg of Boric Acid may also be used upon recurrence, applied intravaginally once daily for 2 weeks.

Treatment of Sexual Partners

As previously mentioned, data regarding complicated VVCs are still murky, especially when it comes to non-albicans VVC. As such, no recommendations regarding the treatment of your previous sexual partner could be provided until diagnoses and assessed by a physician.

Special Precautions

Immunocompromised Individuals

Women who have an underlying condition affecting their immune system, taking an immunosuppressant, or have an uncontrolled diabetic condition would not respond well to the conventional short-term treatments. Treatment should be modified and prolonged to generate the effect of the drugs.

Pregnant Women

Only topical azole therapies applied for 7 days are allowed for pregnant women. Do not self-medicate as other medications might prove to be harmful to you and your baby.

Frequently Asked Questions (FAQs)

Are false-negative results possible for fungal tests?

Yes, and they are extremely predominant when the amount of microbes present in your sample is insufficient to generate an accurate result. This is also the reason why a cell culture is indicated once a wet mount test or KOH Prep comes back negative.

Does consuming “good bacteria” such as probiotics help in restoring the environment of my vagina?

In a way. It is phrased as such because although some studies indicate that eating probiotic yogurt or taking Lactobacillus acidophilus supplements slow down the growth of yeast and fungus in the vagina, more studies are still necessary to ultimately conclude the relationship between the two. Opt for a consultation instead of opting for inconclusive means.

When should I see my doctor about possible yeast infections?

The moment you feel like your symptoms are aligned with everything that was previously mentioned, you should immediately book a consultation with your physician. Many other diseases have similar manifestations as yeast infections. As such, self-medication (despite being relatively sure that you have a yeast infection) could worsen your condition instead. In addition to that, you should always prioritize its treatment while it is still in its uncomplicated stage.

If my fungal culture comes back positive, should I immediately take the medications described previously?

No, and we could not emphasize this more for you. You should never self-medicate. A positive fungal cell culture could likewise be considered a false positive as your vaginal area contains Candida sp. naturally. However, if their number and reproduction are controlled, it is not considered an infection, especially when it does not manifest any signs or symptoms.

Is my sexual partner at risk if we had intercourse while I was infected?

It depends. With men, the risk of infection is extremely low. Around 15% of men develop an itchy and uncomfortable rash after unprotected sex with someone who has a yeast infection, and this might be suitable for a routine consultation with their physician. If you are having intercourse with another woman, on the other hand, they should be checked immediately as they are greatly at risk of contracting the infection.

At what age can we start getting vaginal yeast infections?

Women of all ages could contract the condition without any exceptions. However, they are relatively rare before puberty and after your menopause.

Are long-treatments supposed to be continued even after I feel better?

Absolutely! Even if you start feeling better, you should still follow the prescription that your physician has prepared for you. Not only will it prevent a recurrence, but it will also prevent any instances of resistance where the fungi will no longer be susceptible to the drug that was previously provided for you. Always follow your doctor’s recommendations, and if you have questions, feel free to consult your physician about it.

I am feeling slight discomfort in my genital region. Is there any way for me to get a rough analysis of my symptoms?

Of course! Apart from counterchecking your symptoms from the ones listed above, you may check out this link that provides a test to determine whether your symptoms are aligned with the signs associated with a vaginal yeast infection.

How are vaginal suppositories applied?

In general, suppositories are inserted inside a body’s crevice which is in this case, the vagina. Consult the information packet of the suppository that you bought and it will provide you with a complete guide that you could then follow when using the product.

Is it possible for me to transfer my infection to my baby if I have the infection just before going into labor?

Unfortunately, it is. This is the reason why you should start your treatment immediately as soon as you are diagnosed. The fungus could be transmitted and cause infections such as oral thrush and diaper rash – manifestations of the Candida species in other parts of the body.