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The dreaded yeast

Yeast infections (better known as vulvovaginal candidiasis) are common and primarily impact people of childbearing age. Patient's who are on estrogen containing contraceptives or hormone replacement therapy (both oral and topical) are also prone to developing yeast infections. The use of topical steroids on the vulva or in the vagina can also increase the risk of yeast infection. Other conditions that increase the risk of yeast infections include HIV, diabetes, obesity, incontinence, oral antibiotics, or immune suppressing medications. Diets high in sugar do not impact the risk of yeast infection unless you have diabetes.

It is rare for candida to be spread via penis in vagina penetrative intercourse. The exception to this is if the penis is uncircumcised. In those cases, it can be passed back and forth during penetrative intercourse and both partners should be treated. Sometimes, couples who both have vulvas will need to be treated for yeast at the same time.

Most yeast infections are caused by a yeast called Candida albicans. Symptoms include itching, burning, pain with intercourse, swelling, or fissuring (“cuts”) of the vulva. Other species of yeast that can cause similar symptoms include Candida glabrata, Candida krusei, and Candida tropicalis, and Candida parapsilosis. Depending on the species of yeast, different therapies are used.

Vaginal yeast infections caused by Candida albicans are (for the most part) easily treated with any of several types of medication. Fluconazole tablets by mouth are effective, generally requiring only two tablets to cure an infection. Any prescription or over-the-counter cream or suppository for yeast whose name ends “azole” is equally beneficial; these include miconazole, clotrimazole, terconazole, tioconazole, and butconazole. Any of these medications regularly cures a yeast infection, but some patients experience frequent recurrences. Frequent recurrences are extremely annoying, but not dangerous, and they are not generally a sign of significant, silent underlying illness such as diabetes or an immune problem. If concerned, testing for HIV and diabetes can be easily done. Most often, using regular doses of a yeast medication, such as a fluconazole tablet once a week, or an “azole” cream or vaginal suppository two to three times a week prevents the return of yeast.

Infections caused by non-albicans Candida often are much more difficult to clear. Sometimes they are even just a variant of normal that does not need to be treated! Fluconazole and “azole” creams and suppositories very often do not cure these infections with the exception of clotrimazole cream for some of the non-albicans Candida. In this case, boric acid capsules, compounded by a reliable pharmacy (NOT purchased on amazon), and inserted into the vagina daily for 3 weeks. Boric acid should never be used without the direction of a women's health provider, and it should never be used simply for "maintaining vaginal health."

Thankfully, a new medication to treat vulvovaginal yeast infections has just been approved. This medication, Brexafemme (ibrexafungerp) will likely only be used in situations where the infection has been chronic and persistent and will be a good option for patients who have been on long term fluconazole or in whom boric acid is ineffective.

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