What is a yeast infection?

Swelling, itching, skin irritation, pain and rashes – this is what a fungal yeast infection looks like. Depending on the site of infection, for example in vulvovaginal yeast infection, there can be symptoms like abnormal discharge, pain on urination, pain during sex.

This type of infection is usually caused by a fungus called “Candida”. Candida is a fungus that normally lives in the vagina and the gut, and although present, they do not usually cause symptoms. They cause disease when there is an imbalance in the “normal environment”, resulting in an overgrowth of the fungus.

Why did I get a yeast infection?

Certain medications, like antibiotics, can increase the chance of getting a yeast infection. Other risk factors include states of high estrogen, like pregnancy or while taking high dose contraceptive pills. Compromised immunity through immunosuppressive therapy for cancer or HIV infection, or uncontrolled diabetes, can also increase the change of a yeast infection.

Lifestyle habits such as vaginal douching, wearing tight-fitting underwear, using scented feminine products or staying in wet clothes for long durations can increase the risk of vaginal yeast infections.

How can yeast infections be treated?

Antifungal creams, pessaries (medicines that you put in the vagina), or oral antifungal medications can be used to treat yeast infections. These medicines work by killing the fungus that cause the infections. Your doctor will likely prescribe one or more forms of these when treating your yeast infections. Treatments usually focus on symptom relief, although not all who have such infections require treatment as approximately 10-20% of people are asymptomatic.

Antifungal creams

These topical medicines are used to treat fungal skin and nail infections, and work by stopping further growth and replication of fungal cells. A wide range of available creams which can be bought over-the-counter or via prescription.

Common ingredients in the creams include: Miconazole, Clotrimazole, Ketoconazole, Terbinafine. Do note also that some products include steroids, which are helpful in reducing the swelling or itch experienced during an infection.

The creams are usually applied twice a day – morning and night – to the affected and surrounding areas. Application of a thin layer of cream will do, as too thick of a layer might make the area moist and more prone to secondary infections. Users should continue applying the cream for at least a week after the infection resolves.

Antifungal pessaries

These are medicines used to treat vulvovaginal fungal infections. They are inserted into the vagina, either via fingers or with an applicator and work by clearing the overgrowth of fungus. Common ingredients in the pessaries include: Clotrimazole and Isoconazole. These can be obtained via a prescription from your doctor.

The pessaries are usually applied once to twice a day, depending on the product prescribed. When using pessaries, insert them as deeply into the vagina as possible. Be sure to continue the course as prescribed by your doctor and avoid premature stoppage of use as this may cause the infection to return. Discharge will be expected during the course of treatment, particularly during the initial days, so do consider using a pantyliner to absorb any discharge.

Some things to avoid while on pessaries:

  1. Do not use tampons, intravaginal douches, spermicides or other products to be used in the vagina
  2. Not for use during periods, to resume after period has ended

Oral antifungals

These are medicines used to treat fungal infections affecting the skin, nails, intestinal or vaginal tracts. They work by clearing the overgrowth of fungus as well. Common oral antifungals available are Itraconazole, Fluconazole, Ketoconazole, Terbinafine and Nystatin. These are available via prescription from your doctors.

Do take the dose as prescribed by your doctor, and do not stop the medication without consulting your doctor. It will be helpful for your doctor as well, if you inform him/ her of any other medications or supplements you are concurrently on.

Some things to avoid while on oral antifungals:

  1. If you are pregnant, breastfeeding or planning to become pregnant.
  2. Avoid alcohol due to interactions with several antifungals like Itraconazole and Ketoconazole.

With so many options for treatment, how will I know what is best for me?

Your doctor will assess whether your yeast infection is a complicated or uncomplicated (90% of patients) infection based on the following criteria:

Criteria for uncomplicated infection include all of the following:

  1. Sporadic, infrequent episodes (less than 3 episodes/ year)
  2. Mild to moderate signs/ symptoms
  3. Healthy, non-pregnant women
  4. Candida albicans species

Criteria for complication infection include one or more of the following:

  1. Recurrent candidiasis (more than 3 episodes/ year)
  2. Severe signs/ symptoms
  3. Pregnancy or immune-compromised states like uncontrolled diabetes, immunosuppression
  4. Candida species other than Candida albicans

Complicated infections will require longer courses of treatment, either with oral medication, topical creams, or both. It is unclear whether one route is superior to the other, as comparative studies have not been done. Therefore, treatment will be a joint decision – taking into consideration your preferences, convenience, side effects of drugs, drug-drug interactions, costs, etc. Work closely with your doctor in deciding the treatment option that works best for you, and adhere to the prescribed course.

Dr. Nicole Chen

For more information, please visit DTAP Clinic website, www.dtapclinic.com or email them at hello@dtapclinic.com.sg

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