Yeast Infection

(Thrush, Candidiasis)

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Vaginal yeast infection, also called vaginal thrush or Candidiasis, is caused by a fungus called Candida albicans.

Candida albicans is normally present in the vagina, the skin around the anus as well as the mouth to a greater or lesser degree in many women. It loves an environment with a rich source of glucose and minimally acidic medium.

It becomes pathogenic when there is an overgrowth of the yeast due to changes in the vaginal environment. The ph of the vagina is usually kept acidic by a bacteria called lactobacilli. But if this bacilli dies off due due to any cause such as the use of antibiotics, the ph changes and the yeast can grow abundantly giving rise to the typical symptoms of thrush.

Vaginal yeast infection also occurs when the level of glucose in the body increases, as in pregnancy, while taking oral contraceptive pills and in diabetic patients.

The symptoms of candidiasis decreases during menstruation when the acidity of the vagina is temporarily reduced or by douching the vagina with a solution of sodium bicarbonate. But the main infection is not cured and recurs after some time.

Signs and Symptoms of Candidiasis

  • Vaginal Itching:
  • the main symptom of yeast infection is severe vaginal itching. The itching is out of all proportion to the amount of vaginal discharge seen. The scratching can leave the vulva inflamed, sore and oedematous.

  • Vaginal Discharge
  • The vaginal discharge is typically thick, white and cheesy. Some patients describe it as curdy and somewhat dry.

    The discharge tends to be sticky and may cling to the vaginal walls. On peeling off, it leaves a reddish area that may occasionally bleed (rare).

    Candida albicans

  • Smell
  • Infection with yeast may sometimes produce what is called a "musty smell".

  • Sexual Intercourse
  • Sexual intercourse may be painful and difficult due to the inflamed vaginal walls.

  • On examination
  • The vulva is seen to be red and inflamed. Signs of scratching may be evident around the vaginal opening.

    On examination with a speculum inside the vagina, thick, curdy white discharge is seen clinging to the vaginal walls. Occasional red areas will show where the discharge has fallen off.

    Diagnosis of Candidiasis (Yeast infection)

    The diagnosis of candida albicans is made by examining the vaginal discharge under a microscope to show the presence of the hyphae and spores characteristic of candida.

    The advantage of a microscopical examination is that it will also reveal the presence of Trichomonas vaginalis, if present. Simultaneous treatment of both the organisms can be done.

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  • Antifungal ointments
  • A course of antifungal ointments to be applied over a period of days is the right treatment. Miconazole or clotrimazole, available as both creams and tablets, may be used. If tablets are to be taken, 1 tablet is to be inserted deep inside the vagina every night for a minimum of 3 nights or, if the infection is severe, for 6 nights. The dosage can be increased to 2 tablets per day - 1 tablet to be inserted at night and 1 tablet to be inserted in the morning.

    Antifungal creams of both miconazole or clotrimazole can be applied twice daily inside the vagina for a period of 1 week.

    Combination packs of Miconazole 7-Day and 3 day Treatment regimes are also available. These contain pre-filled applicators to be applied inside the vagina as well as an external cream to be applied on the vulva.

    If the infection continues or returns often, anti-fungal medicine may be needed every day for 10 to 14 days, and then once a week for six months.

    Boric acid capsules may also be used for up to two weeks. They are quite effective, especially in recurrent vaginal yeast nfeciton.

  • Anti-inflammatory tablets
  • Tablets like Ibuprofen and Acetaminophen, will decrease the pain and inflammation of the genital area.

  • Probiotics
  • Probiotics are healthy bacteria similar to those normally presnet in the vagina. They colonise the vagina and normalizes the ph to help prevent recurrent infections.

  • General Measures to Control Vaginal Discharge with Itching
  • General measures like controlling sugar in the urine (home test kits can be used) in diabetics, temporarily discontinuing birth control pills and eliminating any other suspected cause of increasing the sugar level in the body is to be taken.

    In cases of vaginal discharge in pregnancy, only locally applied creams like miconazole or clotrimazole can be used, applied twice daily inside the vagina for a period of 1 week.

    Improving the general condition will contribute to the ability to resist infections.

    Supplements of various nutrients should be taken to boost the immune system of the body. Vitamins like B-Complex Capsules, High strength Multivitamin Capsules, Iron capsules to correct anaemia and Folic Acid tablets should be taken.

    Other sypplementary vitamins and minerals that increase the resistance of the body to infections of various types are Vitamin C 500 mg tablets taken once daily and Acidophilus to increase the growth of healthy lactobacillus in the vagina, increase the acidity of the vagina and prevent infections. Zinc tablets also increase the body's immunity to infection.

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