Yeast Infections
ByGabe Mirkin, M.D.
When a woman develops a white discharge and
vaginal itching, her doctor often diagnoses
yeast infection, even though he may be wrong
because every healthy woman has yeast in her
vagina and cultures of the vagina almost always
grow yeast, even in women who have no symptoms
at all. A doctor diagnoses yeast by inserting
a cotton swab into the vagina, placing it
in a drop of water and examining the fluid
for yeast under a microscope. Cultures should
not be used to diagnose yeast as most healthy
women harbor yeast in their vaginas, mouths
and intestines.
Yeast infections often follow taking
antibiotics or birth control pills, but
when yeast cause a rash on the genitals,
it often is acquired through sexual contact
or it can be caused by immune defects
associated with diabetes or HIV. When
normal healthy people develop rashes caused
by yeast, doctors should look for a cause.
Genital infections caused by yeast are
often associated with a special type of
yeast that is able to break though the
skin to cause a red, itchy rash. Men and
women with genital rashes caused by yeast
either have an immune defect such as diabetes
or they have a special yeast that can
be acquired through sexual contact.
Women who have documented yeast infections
and a rash from it can be cured when they
and their partners take ketoconazole,
400mg daily for 14 days, or fluconazole,
150 mg/day for 4 days. Women who keep
on getting documented yeast infections
may need to take itraconazole 50 to 100mg
daily or fluconazole 100mg weekly or 150mg
monthly. Short courses of topical therapy,
such as clotrimazole or miconazole may
also be used.
Since yeast is a normal inhabitant in
the vagina, it is often diagnosed as the
cause of vaginal itching when it is only
an innocent bystander. When a physician
takes cultures for many different types
of infections and finds only a yeast,
she usually prescribes suppositories (over-the-counter
clotrimazole vaginal suppository, once
a day for three days) to kill yeast and
the patient feels better for a week or
so because the suppository lubricates
the irritated area. Then the itching returns
because these women often are infected
with mycoplasma, which is extraordinarily
difficult to find on culture, and can
be cured when they and their partners
take azithromycin (250 mg once a day for
9 days) to kill the mycoplasma. If a woman
really has a vaginal yeast infection,
she usually clears up with a pill called
fluconazole (150 mg/day for 4 days).
A study from the University of Leeds
shows that women who get yeast infections
over and over, have the same type of yeast
that recurs; it is not a new infection.
This means that women with recurrent yeast
infections and their partners should be
treated for several weeks with oral drugs
to kill yeast such a Diflucan, and not
just with vaginal suppositories.
Dr. Gabe Mirkin has been a radio talk
show host for 25 years and practicing
physician for more than 40 years; he is
board certified in four specialties, including
sports medicine. Read or listen to hundreds
of his fitness and health reports at http://www.DrMirkin.com
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Journal references on yeast infections:
http://www.drmirkin.com/women/W175.htm
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