Understanding Vaginal Yeast Infection Medications

Yeast infections are overgrowths of normally growing fungi in the vagina. Overgrowth inflames the vagina and creates discharge, odor, irritation, and/or itching. Normally growing bacteria in the body typically keep yeast fungi in check. If the natural balance of microorganisms is upset, the yeast may grow out of control. This is so common that 75% of all women experience a yeast infection at some time in their lives. Disruption of this natural balance may occur with any of the following:

• Use of antibiotics
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• Diabetes
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• Excessive use of alcohol
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• Use of douches or feminine hygiene sprays
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• Tight or noncotton underwear
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• Hormonal changes
  
  
  • Ovulation
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  • Menopause
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  • Pregnancy
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  • Use of birth control pills
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  • Use of hormone therapy

Vaginal yeast infections are caused by a fungus. The most common fungus women acquire is called Candida albicans. This is also called candidiasis, genital candidiasis, or vulvovaginal candidiasis (VVC). In stubborn cases, there may be a resistant yeast organism or a mixed infection with Candida as one of the organisms. Yeast infection can spread to other parts of the body, including skin, mucous membranes, heart valves, the esophagus, and other areas. Yeast infection can cause life-threatening systemic infections, typically in people with weakened immune defenses. For example, pregnant women and HIV-infected people are susceptible, as are diabetic people and those taking corticosteroids.

Many women often mistakenly think they have a yeast infection and treat themselves, when they actually have a similar vaginal infection that will not respond to self-treatment with over-the-counter yeast-fighting medications. A recent study by the American Social Health Association found that 70% of women self-treated vaginal infections before calling a healthcare provider. Most often, they mistook a bacterial infection (bacterial vaginosis) for a yeast infection. Other problems that can cause similar symptoms might be just a local mechanical irritation (from sex or tampons), an allergic reaction, or a chemical irritation from soap, perfumes, deodorants, or powders.

Although vaginal infections may cause unpleasant itching, they should not cause pain. If pain is felt in this area, a healthcare provider should be seen.

Women should see a healthcare provider the first time vaginal yeast infection symptoms occur or if they are unsure if they have a yeast infection. If certain, the condition can be treated with over-the-counter medications. However, if symptoms do not respond to 1 course of over-the-counter medications, yeast infection may not be the problem. Pregnant women or those with weakened immune systems should contact a doctor before beginning any over-the-counter self-treatment. Women who experience recurrent vaginal yeast infections, or yeast infections that do not clear up with treatment, should immediately contact a healthcare provider for professional diagnosis and treatment. It is called recurrent vulvovaginal candidiasis (VVC) if a woman has 4 or more proven episodes per year.

Eating yogurt or capsules containing live acidophilus cultures might help. Yogurt acts as a medium in which certain good bacteria thrive. One study showed that women who ate a cup of yogurt each day for 6 months reduced the frequency of vaginal yeast infections. Researchers think the bacteria grow in the gastrointestinal tract and vaginal canal, where they restore or supplement the normal bacteria there and stop the growth of the candidal yeast. Yogurt must contain live bacteria called Lactobacillus acidophilus.

• Oral agents: Fluconazole (Diflucan), ketoconazole (Nizoral), itraconazole (Sporanox)
  
  
• Vaginal agents: Butoconazole (Femstat), clotrimazole (Mycelex, Gyne-Lotrimin, FemCare), miconazole (Monistat-7, Femizol-M), nystatin (Mycostatin), terconazole (Terazol), tioconazole (Vagistat-1)
  
  
• How antifungal drugs work: Antifungal drugs inhibit the ability of fungus to multiply and form new cell membranes.
  
  
• Who should not use these medications: Individuals with allergy to any ingredients contained within these products should not take them.
  
  
• Use: The choice of oral or vaginal dosage forms depends on the severity of the yeast infection, whether infection is recurrent, and the individual’s personal history (for example, immune system status, pregnancy, diabetes). Some drug regimens may include a combination treatment of an oral agent followed by vaginal application of a cream or vaginal suppository. Severe or recurrent infections may require maintenance treatment prescribed by a doctor. Maintenance treatments are taken periodically (for example, once per week).
  
  
  • Oral agents: These prescription drugs are available as tablets or capsules. Various treatment regimens are used. Patients with mild infections may require only a single dose or daily doses for a short duration.
    
    
  • Vaginal agents: Some vaginal preparations are available without a prescription. Vaginal dosage forms include vaginal suppositories or creams that come with special applicators for proper administration.
  
  
• Drug or food interactions: Clinically important drug interactions may occur with orally administered ketoconazole, fluconazole, or itraconazole. Patients should check with their doctor or pharmacist if they are currently taking other medications. Antacids or other drugs that decrease stomach acidity (for example, Pepcid, Tagamet, Zantac) may decrease the effectiveness of oral antifungal drugs.
  
  
• Side effects: The most common side effect experienced with vaginally applied treatments is vaginal burning and itching. Less common effects of vaginally applied treatments include contact dermatitis, irritation, inflammation, and pain with urination or intercourse. Common side effects with oral treatment include dizziness, fever, mild itching, nausea, bad taste, or diarrhea. Creams and suppositories may contain oil and weaken latex condoms.

|Web Links|

US Centers for Disease Control and Prevention (CDC), Genital Candidiasis

understanding vaginal yeast infection medications, fungus, fungi, yeast fungi, vagina, vaginal infection, vaginal discharge, vaginal odor, vaginal irritation, vaginal itching, douches, feminine hygiene sprays, Candida albicans, C albicans, C. albicans, candidiasis, genital candidiasis, vulvovaginal candidiasis, VVC, resistant yeast organism, bacterial vaginosis, Lactobacillus acidophilus, Lacidophilus, yeast infection

Author: Mary L Windle, Pharm D, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, .com, Inc.

Editors: Suzanne R Trupin, MD, Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Lee P Shulman, MD, Professor of Obstetrics and Gynecology, Head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.