Yeast Vaginitis
From Encyclopedia of Sex and Sexuality
A nonmedical term used to describe symptomatic vaginal infections caused by an overgrowth of fungi. This, and bacterial vaginosis, are the two most common agents found in women seeking medical care for vaginal infections. The most common fungus causing this infection is Candida albicans, but infections can also be caused by Candida tropicalis and Torulopsis glabrata.
The diagnosis of a yeast infection can be confirmed by an examination of vaginal secretions. A woman should suspect this infection if she has an excessive vaginal discharge accompanied by itching, particularly when this begins during or following antibiotic treatment, usually for an unrelated complaint. In these symptomatic women, a microscopic examination of vaginal secretions often reveals yeast forms. A culture can also be obtained for confirmation and is a more sensitive diagnostic test than microscopic examination.
The initial treatment of an acute vaginal yeast infection is with a local agent, available as a cream, suppository, or vaginal tablet. Fortunately, few of these yeast forms are resistant to therapy. In chronic or recurrent cases, oral antifungal medications can be employed if the cultured fungal organism is resistant to the local antifungal medications or if the patient has developed a local sensitivity from repeated use of vaginal creams and suppositories.
There is considerable misunderstanding of the nature of vaginal yeast infections in women. Recurrent yeast infections are not usually caused by a foreign fungal form that must be eliminated by chemotherapy from all sites in the body for a cure. In the normal woman, the number of yeast organisms on the skin or surface of mucous membranes is kept at low or undetectible numbers through the competition of normal surface bacterial flora for a finite amount of nutrients and an efficient local defense mechanism mediated through white cells and their metabolic products of defense, the cytokines. Any change in this complex, competitive environment can tip the balance, allowing yeast overgrowth. There are many examples of this delicate balance going astray and, if the imbalance is not rectified, repeated use of antifungal agents will not work. Examples include pregnant women, who have an increased amount of sugar in their urine and vaginal secretions, a metabolic environment that favors yeast overgrowth, and women taking antibiotics; the antibiotics kill much of the normal bacterial flora in the Vagina and allow an overgrowth of yeast forms. Also, intercourse with an infected male, often uncircumcised, may introduce more yeast forms to the vagina, shifting the normal balance. Another example is the lowering of the vaginal cellular response that can occur through diseases like HIV infection, or through treatments such as immunotherapy for cancer.
These can all result in repeated vaginal fungal infections. In recurrent infections, the goal should be to restore the microbiological balance of the vagina. Antifungal agents are only the first step. The key to finding an effective cure is determining what is modifying the local host response. If this can be corrected, a cure can be achieved; without this, antifungal treatment is destined for failure.
