Yeast infections are best treated by your medical provider

Trying to treat a vaginal yeast infection with over-the-counter remedies can be a mistake, said Hyannis gynecologist Eva Strobl, MD.

“I recommend that anytime you have symptoms of yeast infection, come see us in the office so we can test for yeast, because you can also have another condition that wouldn’t be treated by over-the-counter medications like Monistat. Bacterial vaginosis, for example, is very common and that is treated with an antibiotic.”

Vaginal yeast infections can cause an itching and burning sensation that can be extremely uncomfortable. The National Institute of Health estimates that about 75 percent of all women will have at least one yeast infection - an overgrowth of the yeast Candida albicans - in their lifetime.

There are plenty of over-the-counter treatment options available at any pharmacy, and Dr. Strobl, who practices at Cape Cod Hospital OB/GYN said that in her experience most women choose that option and don’t come in for an appointment unless those medications don’t work.

But checking in with your gynecologist can quickly determine what the actual problem is. A simple vaginal swab is all that is needed to test for a yeast infection. Lab results are usually back in two to three days, she said.

Another problem with taking an over-the-counter medication is that a lot of women are tempted to go for the high-dose one-day treatment option instead of the longer three-day or seven-day treatment. Since it is the same dose of medication that is delivered all at once rather than over time, it can cause a chemical irritation that mimics the very symptoms women are trying to eliminate.

“Any high dose of medication can have adverse effects and if there is an option to take the lower dose for a longer period of time, it’s a good idea,” Dr. Strobl said.

The Treatment

When patients with a yeast infection come to see her, she treats them with either a one-day oral medication in pill form or a seven-day course of vaginal cream. Both are equally effective at treating the yeast infection and patients tolerate both pretty well. The one-day pill is very popular, but not everyone can take it. One of the largest contraindications is pregnancy.

“In pregnancy, we recommend the cream because any topical would have less systemic absorption and less risk to pregnancy,” she said. “But for non-pregnant patients without any other type of contraindication, oral therapy is what most patients prefer and it’s just as effective.”

In an interesting twist, for a lot of women, pregnancy actually causes their first yeast infection. That’s because pregnancy raises women’s hormone levels and higher estrogen can cause an overgrowth of yeast because it affects the pH of the vagina. Diabetes also can cause yeast infections because high sugar levels also affect vaginal pH, Dr. Strobl said. Even though studies are mixed, for some women, the estrogen in oral birth control can be a cause.

Dr. Strobl prescribes birth control pills every day, and she doesn’t see this as a big problem for many women, but since there is research to suggest it could be, she does keep it in mind.

“I would only really associate a yeast infection with birth control pills if we tried to treat it and it’s not going away,” she said. “Then we need to think about other things that might be causing the problem.”

Another area that has mixed study results is whether a male partner can reinfect a woman. It is definitely something to consider if a person has recurrent yeast infections, Dr. Strobl said. Even though you can be sexually active during treatment, most women choose not to because it’s uncomfortable.

Antibiotics and Yeast

Aside from pregnancy and diabetes, one of the most common reasons women get yeast infections is while they are taking an antibiotic. Antibiotics kill the good bacteria along with the bad bacteria, which can also alter the pH balance of the vagina. Dr. Strobl recommends discussing this possibility with the prescribing doctor.

“If you are on antibiotics and you are someone who has had a yeast infection after an antibiotic use you could ask your doctor for treatment of a yeast infection, based on your history, and take a Diflucan (oral medication) at the beginning and end of your course of antibiotics.”

There is no absolutely proven way to prevent yeast infections, but Dr. Strobl has seen studies that indicate that boric acid suppositories could help prevent them in women who are predisposed to get them. She would only recommend this if a woman has had three or more yeast infections in a year.

“The interesting thing about my field is that every woman is different,” she said. “I always have to think about that when normal treatments aren’t working for yeast infections. You have to look at the whole picture and it could even be like a foreign body like an IUD or a diaphragm. We don’t have evidence to tell us that it would cause a yeast infection, but if the patient is struggling to fight off yeast infections concurrently it’s something to consider changing.”