What is Recurrent Yeast Infection?

1 in 2 women older than 25 have had one yeast infection, but less than 1 in 20 women experience recurrent infections. An infection is considered recurrent if you’ve had at least four episodes in a year, three if the infection wasn’t due to taking antibiotics.

Note: This is different from a persistent infection in that there are periods where one does not experience any symptoms.

Common Symptoms

• Intense vaginal discomfort
• Odorless vaginal discharge
• Itching
• Genital pain before, during, after sex
• Pain & discomfort urinating

It’s important to see your healthcare provider for proper diagnosis as it’s easy to miss concurrent infections involving two or more types of bacteria with self-diagnosis. Proper diagnosis is necessary to effectively treat the infection.

What causes Recurrent Yeast Infection?

Yeast infections (Vulvovaginal Candidiasis) are typically caused by an overgrowth of Candida albicans, a type of yeast that is naturally present in our bodies, but increasingly other pathogens such as Candida tropicalis and Candida glabrata have been found to also cause infections. Antibiotic resistance of these other pathogens is suspected to be the major cause of chronic yeast infections.

Some other factors that can increase the likelihood of developing recurrent infections include:

• Imbalance in vaginal bacteria: Chronic yeast infections can happen when there’s an imbalance or variation in vaginal bacteria. These bacteria normally help keep Candida from overgrowing but an imbalance can occur when too much bacteria are removed via antibiotics and douching. Contraceptives such as spermicidal jellies and creams and hormonal changes such as during menstrual cycles or pregnancies can also disrupt the balance. Women who take oral contraceptives have a higher rate of yeast infections.
• Weakened immune system: You’re also at risk of recurring yeast infections if you have a weakened immune system, which can be due to age, certain medications or health conditions.
• Incomplete treatment: If the initial yeast infection wasn’t completely treated, it may recur.
• Transmission: Candida infections can happen on other areas of skin and in the mouth. They can spread via skin-to-skin contact so it’s possible to transmit the infection back and forth between partners.
• Diabetes: While high blood sugar levels have been thought to create an environment where the yeast thrives, people who have recurrent infections have rarely been diabetic.

If an infection recurs at least three months after the previous infection, it is more likely to be caused by a different strain. It’s important to identify the underlying cause of recurrent yeast infections to effectively manage and prevent them. A healthcare professional can help determine the best course of treatment.

Treatment

Treatment for infections should be tailored to the individual, taking into account factors like effectiveness, convenience, potential side effects, and cost. For those who experience infrequent recurrences, early self-diagnosis and topical therapy are generally advised. Once the immediate infection is managed, ongoing treatment is often necessary to prevent future episodes. However, long-term use of medications can lead to resistance, making it essential to consult a healthcare provider for the most appropriate course of action.

If standard treatments prove ineffective, the issue could be a non-C. albicans infection. In such cases, Terconazole vaginal cream is often recommended. Various antifungal medications, including ketoconazole, clotrimazole, and terconazole, have been researched for their efficacy in ongoing treatment.

Treating Recurrence

Taking maintenance medication is important for stopping infections from coming back, but the best timing and how often is still not certain. Boric acid can be used for tough-to-treat infections, but it can cause irritation and even poisoning.

To help prevent infections from returning, you can use medications like ketoconazole, clotrimazole, terconazole, fluconazole, and itraconazole. Doctors usually recommend taking preventive medication for six months. After that, they'll check how you're doing. It's important to know that many women have symptoms come back after they stop taking preventive medication, so they might need to take it for a longer time.

Fluconazole is generally safer than ketoconazole and easier to take because it's a pill. However, it can cause headaches, stomach pain, and nausea for some people. Also, fluconazole and similar medications can interfere with other drugs like blood thinners, diabetes medication, and epilepsy drugs, so you need to manage these carefully.

Conclusion

Dealing with repeat yeast infections can be tough both physically and emotionally. They can make you uncomfortable and disrupt your life, but knowing why they happen and how to treat them is the first step to managing them better. It's important to talk to a healthcare provider for a correct diagnosis, as trying to figure it out yourself can lead to misdiagnosis. By getting the right medical advice and sticking to a treatment plan, you can cut down on how often you get these uncomfortable infections.

References

Horowitz BJ. Mycotic vulvovaginitis: a broad overview. Am J Obstet Gynecol. 1991;165:1188-92.

O'Connor MI, Sobel JD. Epidemiology of recurrent vulvovaginal candidiasis: identification and strain differentiation of Candida albicans. J Infect Dis. 1986;154:358-63.

Fong IW. The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin Med. 1992;68:174-6.

Yeast Infection Testing & Treatment