Doctors Lounge - Gynecology Answers
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Forum Name: Gynecology
|kdlady - Mon Feb 13, 2006 4:34 pm||
I am a 25 year old female with one child. I am married and my husband is my only sexual partner. I have an IUD that was inplanted 3 years ago and has given me no problems. I was admitted to the hospital for one week last May '05 for severe tonsilitis that wasn't responding to antibiotics or steroids. I was put on Antibiotics and steroids for about three months following the hospital visit. Beginning last May while being treated for tonsilitis, I began to have symptoms of what I though was a yeast infection. I had thick cottage cheese like discharge, severe itching, and so on. I was given Diflucan for 7 days and got no pelvic exam, but the symptoms seemed to go away for a bit. Ever since then, I get this type of infection every month. It starts the week after I finish my period and lasts about two weeks. I use over the counter vagisil, but it really doesn't help. The itching is so severe and I have what look like cuts inside my labia that really hurt. I have seen my Doctor who has tested me for all STDs and for yeast infections, but I have all normal tests. In my smears, the doctor saw lots of pus and said my pH levels were very off. She gave me a shot of an antibiotic, but my symptoms are still present. If I don't have yeast infections or STDs, what do I have. I don't have insurance and so I hate to keep going to the same doctor who can't seem to figure out what is wrong with me. Any ideas? Thanks
|Dr. Tamer Fouad - Wed Feb 15, 2006 3:46 pm||
Cross-sectional studies support that 5% of women experience recurrent vaginitis. Resistant and recurrent vaginitis is more common with atypical Candida species (eg, Candida glabrata). This finding is supported in a number of prospective cohort studies of women with troublesome vaginitis.
Candida albicans is the infecting agent in 80 to 90 percent of patients. Recently, the frequency of non-albicans species (eg, 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.[5,6,7]
Other risk factors include young age at first intercourse, intercourse more than four times per month and receptive oral sex.[8,9,10]
The risk of vulvovaginal candidiasis is also increased in some women who have diabetes, are pregnant or are taking antibiotics.[8,11]
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.
Other risk factors for recurrent vaginits include repeated douching or receptive anal intercourse.
Maybe you should take the opinion of a genito-urinary infection specialist. Also look into the possibility of atypical candidiasis.
1. Nyirjesy P, Seeney SM, Grody MH, Jordan CA, Buckley HR. Chronic fungal vaginitis: the value of cultures. Am J Obstet Gynecol. 1995;173:820-3.
2. Spinillo A, Pizzoli G, Colonna L, Nicola S, De Seta F, Guaschino S. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis. Obstet Gynecol. 1993;81:721-7.
3. Sobel JD. Vaginitis. N Engl J Med 1997;337:1896-903.
4. Horowitz BJ, Giaquinta D, Ito S. Evolving pathogens in vulvovaginal candidiasis: implications for patient care. J Clin Pharmacol 1992;32:248-55.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. 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.
11. 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. Horowitz BJ. Mycotic vulvovaginitis: a broad overview. Am J Obstet Gynecol 1991;165:1188-92.
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