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- Wed Dec 29, 2004 3:38 pm
I am a 23 year-old-female. I started getting yeast infection periodically starting from 17 years old. I was treated for vaginal infections several times since then. In july 2003 I had an abortion, after which the doctor prescribed me the birth-control pills (Ovcon35). In october I overdosed these pills and had a breakthrough period. After a week break I started taking Ovcon35 again. On Dec.16 vaginal itching, burning and had chunky white discharge. I used a 1-day yeast-treating cream. On dec. 18 I had periods again (for the 2nd time this month, 1st time was on dec. 1-5). Today is dec. 29, but the bleeding does not stop. In fact the discharge became very dark, olmost black. I am very scared, what can it be connected to? Is it the pills, or I might have an infection? I regularly have sex without using the condoms. I will really appreciate a professional reply.
| Dr. Tamer Fouad
- Wed Jan 04, 2006 5:24 pm
Vulvovaginal candidiasis is the second most common cause of vaginitis in the United States and the most common cause in Europe. An estimated 75 percent of women have vulvovaginal candidiasis at some time in life, and approximately 5 percent of women have recurrent episodes.[2,3-5] Candida albicans is the infecting agent in 80 to 90 percent of patients.[6,7] Recently, the frequency of non-albicans species (e.g., Candida glabrata) has increased, possibly secondary to greater use of over-the-counter antifungal products.
Studies have shown that the risk of vulvovaginal candidiasis (yeast infection) is increased in women who use oral contraceptive pills, a diaphragm and spermicide, or an IUD.[8,9,10]
Other risk factors include young age at first intercourse, intercourse more than four times per month and receptive oral sex.[3,5,11,12,13]
The risk of vulvovaginal candidiasis is also increased in some women who have diabetes, are pregnant or are taking antibiotics.[3,11,14]
Regarding the recurrence of yeast infection. First, evaluation of the causative organisms and any risk factors for recurrence will be required.
The optimal treatment for recurrent vulvovaginal candidiasis has not yet been defined
In vitro studies have shown that imidazole antifungal agents such as miconazole and clotrimazole are not as effective against nonC. albicans fungi. C. tropicalis and C. glabrata are 10 times less sensitive to miconazole than is C. albicans.
Terconazole vaginal cream (Terazol) is the agent of choice when infection with a species other than C. albicans is suspected. The potent interference of this agent with the cytochrome P450 isoenzymes makes C. tropicalis and C. glabrata more susceptible to treatment.
1. Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol 1991;165:1168-76.
2. Monif GR. Classification and pathogenesis of vulvovaginal candidiasis. Am J Obstet Gynecol 1985;152:935-9.
3. Foxman B. The epidemiology of vulvovaginal candidiasis: risk factors. Am J Public Health 1990;80:329-31.
4. Sobel JD. Candidal vulvovaginitis. Clin Obstet Gynecol 1993;36:153-65.
5. Geiger AM, Foxman B. Risk factors for vulvovaginal candidiasis: a case-control study among university students. Epidemiology 1996;7:182-7.
6. Sobel JD. Vaginitis. N Engl J Med 1997;337:1896-903.
7. Horowitz BJ, Giaquinta D, Ito S. Evolving pathogens in vulvovaginal candidiasis: implications for patient care. J Clin Pharmacol 1992;32:248-55.
8. Barbone F, Austin H, Louv WC, Alexander WJ. A follow-up study of methods of contraception, sexual activity, and rates of trichomoniasis, candidiasis, and bacterial vaginosis. Am J Obstet Gynecol 1990; 163:510-4.
9. Spinillo A, Capuzzo E, Nicola S, Baltaro F, Ferrari A, Monaco A. The impact of oral contraception on vulvovaginal candidiasis. Contraception 1995;51:293-7.
10. Hooton TM, Roberts PL, Stamm WE. Effects of recent sexual activity and use of a diaphragm on the vaginal microflora. Clin Infect Dis 1994;19:274-8.
11. Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol 1998;178:203-11.
33. Spinillo A, Capuzzo E, Acciano S, De Santolo A, Zara F. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol 1999;180:14-7.
12. Skinner CJ, Stokes J, Kirlew Y, Kavanagh J, Forster GE. A case-controlled study of the sexual health needs of lesbians. Genitourin Med 1996;72:277-80.
13. Eckert LO, Hawes SE, Stevens CE, Koutsky LA, Eschenbach DA, Holmes KK. Vulvovaginal candidiasis: clinical manifestations, risk factors, management algorithm. Obstet Gynecol 1998;92:757-65.
14. Spinillo A, Capuzzo E, Acciano S, De Santolo A, Zara F. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol 1999;180:14-7.
15. Horowitz BJ. Mycotic vulvovaginitis: a broad overview. Am J Obstet Gynecol 1991;165:1188-92.
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