Genital Candidiasis
What is Yeast Infection?
Candidiasis is an infection caused by Candida albicans. This yeast is normally present in the mouth, vagina, and feces, but the amount of yeast is controlled by bacteria in those areas. A yeast infection results when the bacteria population is disturbed by the use of antibiotics, or if other conditions are present that promote yeast growth, such as pregnancy, use of oral contraceptives or corticosteroids, diabetes, hypothyroidism, hypoparathyroidism, or Addison's disease. The resulting infection can affect the genitals, skin, mucous membranes, and the esophagus.
Candida infection of the mouth is called thrush. It is most likely to affect individuals who are on long-term drug therapies, such as antibiotics, corticosteroids, or chemotherapy; have diabetes mellitus, anemia, acquired immune deficiency syndrome, or debilitating diseases.
Thrush is common among those who wear dentures. Men may develop candidiasis from an infected sexual partner or as a complication of diabetes mellitus.
Systemic candidiasis usually occurs in individuals with deficient or suppressed immune systems. The infection usually manifests as esophagitis, sepsis, endocarditis, or meningitis.
How is Yeast Infection diagnosed?
Yeast Infection signs and symptoms
Plaques (patches or flat areas) with the following characteristics:
- Bright red patches with poorly defined borders. They are often 6 cm to 12 cm in diameter or larger.
- Some plaques are weeping or oozing.
- Skin appears moist and crusted.
- Itching is usually severe.
- Smaller plaques (less than 1 mm in size) sometimes surround larger plaques. They rarely form small pustules (small white blisters with pus inside).
Genital candidiasis (yeast infection) is one of several types of genital disorders, many of which exhibit similar symptoms. Proper diagnosis is essential to effective treatment. Many people diagnose themselves with a yeast infection based on the symptoms and past experience with the condition. However, the misdiagnosis of yeast infections is common. A study conducted by the American Social Health Association found that 70 percent of women self-treated vaginal infections before calling a healthcare provider. Most often, the women mistook a bacterial infection for a yeast infection. Other problems that people may assume are yeast infections may be irritation from sexual intercourse or tampons (in women), or an allergic reaction.
Following self-diagnosis, people may choose to use over-the-counter (OTC) medications for treatment. Roughly two-thirds of all OTC medications sold to treat yeast infections were used by people who did not have the condition, according to the U.S. Centers for Disease Control and Prevention (CDC). For this reason, people should consult their physician the first time symptoms of a possible yeast infection occur or if they are unsure if they have a yeast infection. In addition, all women who are (or may be) pregnant or breastfeeding must consult their obstetrician-gynecologist (ObGyn) before beginning any treatment. There are some medications that cannot be used by these women.
To diagnose a yeast infection, physicians usually first rely on the symptoms described by the patient. It is important to pay close attention to the symptoms, particularly the time when they first occurred, type of discharge and location of irritation. Women are advised not to douche prior their physician’s appointment as it may mask the symptoms or make accurate testing more difficult.
The physician will obtain the patient’s medical history, including current symptoms. For women, the physician will conduct a pelvic examination. The examination will focus on signs of inflammation or irritation in and around the vagina as well as any vaginal discharge.
The physician may conduct a slide test to analyze the vaginal discharge in women or fluid from the penis in men. In a slide test, the physician will obtain a sample of the genital secretions for a quick examination under a microscope for the presence of yeast organisms, such as Candida. This test is sufficient for diagnosing yeast infection in first-time patients and those with occasional infections. However, in both women and men, cases of recurrent or resistant yeast infections may require further analysis with a genital culture, which is used to identify the presence of other disorders as well as sexually transmitted diseases. The analysis can also aid in diagnosing yeast infections caused by less typical fungi that are often resistant to common yeast therapies.
How is Yeast Infection treated?
The OTC medications for yeast infections are antifungal drugs that work to break down the wall of the Candida organism until it disappears. The drugs also inhibit the ability of the fungus to multiply and form new membranes. OTC medications for yeast infections contain one of four active ingredients:
The medications for treatment are available in two forms: topical and oral. Topical medications are available by prescription and OTC. They include vaginal creams and ointments that are inserted by the woman into the vagina using a special applicator, or creams that can be applied to the penis. Vaginal suppositories that dispense medicine as they dissolve can also be placed directly into the vagina for treatment. Treatment with these medications can range from several days to two weeks.
Oral medications are only available by prescription and come in the form of tablets or capsules. The dosage and frequency depends on the severity of the yeast infection. People with mild infections may only require a single dose or daily doses for a short duration.
The use of oral or topical forms of medication depends on a number of factors, including the severity of the yeast infection and whether or not the infection is recurrent. A patient’s personal medical history also affects the type of medication that should be used. For example, certain medications should not be used by pregnant women or individuals with a comprised immune system or diabetes. People with these conditions must consult with their physician before beginning treatment for yeast infections.
Some drug regimens may include a combination of treatments, such as an oral agent followed by topical application of a cream. Severe or recurrent infections may require changing the type of medicine or remaining on a medicine for maintenance treatments.
Drug or food interactions may occur with several types of oral medications. Antacids or other drugs that decrease stomach acidity may decrease the effectiveness of oral antifungal drugs. In addition, creams and suppositories may contain oil that can weaken latex condoms. Patients should check with their physician or pharmacist if they are taking other medications before starting yeast infection treatment.
The most common side effects experienced with topical medications include burning or itching of the vagina or penis. Less common side effects include contact dermatitis, inflammation and pain during urination or sexual intercourse. Common side effects with oral medications include fever, dizziness, mild itching and nausea.
Yeast infections generally respond to treatment within a few days. However, individuals are instructed to complete the entire course of treatment, even if symptoms subside before treatment has concluded. It is important to note that although these treatments have an 80 percent to 90 percent success rate, frequent or prolonged use can reduce their effectiveness, according to the U.S. Centers for Disease Control and Prevention (CDC).
If an infection clears up for a period of time but the same symptoms reappear, the patient may be advised by a physician to use a different type of treatment. A new type of medication may be able to completely cure the infection. People should contact their physician if:
- All of the symptoms do not go away completely
- The symptoms return immediately or shortly after completion of treatment
- They have any serious medical problems such as diabetes or immune disorder
- They are pregnant or breastfeeding
Antifungal drugs for yeast infections
Antifungal topical medications are usually prescribed.
Gently massage a small amount into the affected area as
directed. Use only enough to cover. Larger amounts
don't help.
Additional Information
Predicted outcome
Prognosis may depend on the treatability of the condition that precipitated candidiasis.
Alternatives
Candidiasis must be differentiated from other skin infections such as intertrigo (dermatitis located in the skin folds), seborrheic dermatitis, tinea cruris ("jock itch"), psoriasis, and erythrasma.
Appropriate specialists
Internist, gynecologist, dermatologist and infectious disease specialist (for systemic Candida infection).
Notify your physician if
- You or a family member has symptoms of candidiasis.
- The following occur during treatment:
- Infection continues to spread, despite, treatment.
- Signs of secondary bacterial infection develop (pain, tenderness, redness, warmth, oozing).
- New, unexplained symptoms develop. Drugs used in treatment may produce side effects.