Yeast vulvo vaginitis - Women's Health Update

Townsend Letter for Doctors and Patients,  Jan, 2003  by Tori Hudson

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Overview

Vaginal infections are responsible for an estimated 10% of all visits by women to their health care practitioners. There are three general categories of vaginitis; hormonal, irritant and infectious. Hormonal vaginitis includes the atrophic vaginitis usually found in postmenopausal or postpartum women, but occasionally in young girls before puberty. Irritant vaginitis can be due to allergies including condoms, spermicides, deodorants, soaps, perfumes, semen, or douches. Irritants may also be due to hot tubs, mechanical abrasion, sanitary napkins, tampons, toilet tissue, topical medications, or foreign bodies. All of these may cause vaginitis. More than 90% of vaginitis in reproductive-age women is due to an infectious cause of one of three types: bacterial vaginosis, candidiasis, or trichomoniasis. There are other less common infectious causes like gonorrhea, chlamydia, mycoplasma, herpes, campylobacter, and even parasites like pinworms and giardia.

Candida vaginitis

In the United States, currently, Candida is the second most common cause of vaginal infections. Candida albicans is the most common organism in vulvovaginal candidiasis (VVC). There are more than 150 species of Candida, although only nine are considered to be clinically significant in humans. In recent years, the non-albicans species seem to be occurring increasingly and this may be due to the 1-to-3 day drug treatments that effectively suppress Candida albicans but may facilitate the overgrowth of non-albicans species. In the end, this may make it more difficult to treat VVC. Some women who culture positive for Candida do not have any symptoms of vaginitis. Candida is a normal part of the vaginal flora until some mechanism triggers the process into a symptomatic condition.

Acute itching and vaginal discharge are the usual presenting symptoms of VVC. The discharge is typically described as cottage cheese-like in character but it may actually vary from watery to thick. Symptoms may also include vaginal soreness, irritation, vulvar burning, inflammation and swelling of both the internal and external genital tissue, redness, pain with vaginal sexual activity and urinary discomfort. The symptoms are often worse the week preceding the onset of menses with some relief after the menstrual flow.

Unfortunately, self-diagnosis of VVC by women is unreliable too much of the time, making it even that more questionable that so many over-the-counter self-treatments are available. In a study assessing the ability of women to accurately self-diagnose yeast infections without the benefit of potassium hydroxide or culture confirmation, 2 out of 3 women misdiagnosed vulvovaginal candidiasis. (1) The most Candida-specific symptom is itching without discharge, and even this criterion correctly predicts VVC in only 38% of patients. (2)

The greatest concern in self diagnosing and self-treating VVC is in women who have recurrent VVC, which is defined as four or more Candida-confirmed episodes of symptomatic infection within 1 year. This occurs in approximately 5% of women. (3) Recurrent VVC commonly affects women who are immunocompromised as the result of AIDS or other predisposing conditions such as diabetes, Cushing's disease, Addison's disease, hypo- or hyperthyroidism, leukemia. The danger then, is that the underlying condition goes undiagnosed and is delayed in diagnosis because the woman is repeatedly treating herself for what she thinks are simple vaginal yeast infections. There are other predisposing factors in causing recurrent infections that may also need to be addressed: High-estrogen medication, antibiotics, hormones, contraceptive devices, cytotoxic drugs, immunosuppressive drugs, radiotherapy or chemotherapy, tight clothing, nylon underwear, pregnancy and excessive sugar in the diet. Reinfection may also come from extravaginal sources. Although the sexual transmission of Candida is still considered controversial, there is evidence that sexual transmission might be a likely source of recurrent infection.

Even more controversial is whether reinfection can occur from an intestinal reservoir. Many alternative practitioners address chronic Candida vaginitis by also addressing the possibility of migration from rectum to vagina and therefore treating the overgrowth of candida in the digestive tract. Although numerous studies have failed to yield definitive results, it may provide a useful avenue of treatment in especially chronic and resistant cases. (4)

Prevention Concepts

Preventing infections is almost always better than treating them. Here are some simple strategies that have been associated with reducing the frequency of VVC:

* Tight clothing can predispose the wearer to candidiasis. (5)

* Women who wear panty hose have about three times more yeast vaginitis infections than non-wearers. (6)

* Support a healthy vaginal ecosystem and immune system by having a generally whole foods diet and very little to no sugar and refined carbohydrates. There has been no good research data on the association of diet with VVO with the exception of acidophilus yogurt. That being said, a woman with a chronic condition presents a good opportunity to be coached in improved nutritional habits that will have many lifelong health benefits.