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Dr. Andrew Rynne

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Suggest treatment for recurrent yeast infections

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Dr. Madhuri N Bagde

OBGYN

Practicing since :2001

Answered : 1390 Questions

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Posted on Thu, 14 Aug 2014 in Skin Hair and Nails
Question: My daughter XXXXXXX has been battling a recurrent yeast/bacterial infection for two months now. She has been seen by her OB GYN several times, as well as a dermatologist due to the skin infection in the anal area that has now appeared. It seems that we can't get the yeast infection under control. She has been on diflucan, and a cream on an off since May. Now the cream burns her so we have stopped. Last week her gynecologist put her on a 5 day application of metradinazole vaginally which helped during the week and for 3 days. As of yesterday, she felt it coming back- inclusive of discharge. This week she is due with her period.
I am at my wit's end with this and it is very upsetting. I spoke with her dr. last night and she said she wants XXXXXXX off all meds for two weeks to let her body try to sort it out. I am concerned that the yeast infection will begin raging again and spread to the anal area again (which seems to be under control.) From your experience, should XXXXXXX be on metradinazol by mouth ? That seems to have a higher success rate from my research.
I am asking for her medical records today and going to seek out a gynecologist at a NY top hospital. Do you think I should be taking her to an internist or a different specialist or should I stay with a gynecologist ?

Just don't know what more to do on this. Should we be controlling her sugar or yeast intake ? or keep a food diary ? Some people say that that could affect this as well.
Help!

Much appreciated-
XXXX
doctor
Answered by Dr. Madhuri N Bagde 1 hour later
Brief Answer:
detailed answer below

Detailed Answer:
Hello and welcome dear XXXX

I understand your concern well.

Please do not worry. Things will sort out.

I understand that your daughter is 21 years and is having recurrent yeast infections. They are not responding to treatment.
She has received metronidazole and it has recurred.

First of all metronidazole is not active against yeast. Yeast is a fungus and metronidazole is an antibiotic and not an antifungal agent. So metronidazole acts against bacteria and certain parasites like gardenella vaginalis. Hence it is not advisable to use it for treating a confirmed yeast infection.

If she is having the issue since a long time then swabs and microscopy must have been done and I assume that yeast is confirmed.

Now about the management. I will first explain the female vaginal physiology and then you can decide about the management options.

The vagina has naturally got a few bacteria inside it called vaginjal flora. They are a normal part of the vagina and thier presence is very important for vaginal health. If there are infections or repeated use of antibiotic s then this normal flora gets disturbed and then other organisms like yeast [ we call them opportunists as they grow only when the normal ones are decreased] begin to overgrow and cause infection. The predisposing factors for these are repeated use of antibiotics so that the vaginal organisms are killed, douching as water affects the vaginal ph and hence normal organisms cannot grow or decreased immunity due to any reasons like diabetes or HIV etc.

So as of now she has already received too many drugs. I agree with your doctor who says that let it rest for a while. Use of probiotics is the only treatment advocated now. I would also advise to rule out other concomittant infections like bactrial or parasitic ones that may also lead to vaginal discharge.

Metronidazole is not recommended at present as it does not act against yeast.

An immunological evaluation as well as blood sugar testing is also needed.

With these it will be possible to move forward. Also do not use local steroid creams as they decrease local immunity and hence predispose to infections.

Consulting a gynecologist will be fine as we are the ones that commonly deal with these issues and you have already seen a dermatologist. Drugs active against yeasts are fluconazole and ketoconazole and not metronidazole. So kindly please reconfirm which drug you meant.

Do not worry. Let me know if there are any more queries.

Hope this satisfies your query.
Thanks for using HCM.     
Feel free to ask any more questions that you may have.
Dr Madhuri Bagde
Consultant Obstetrician and Gynecologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Madhuri N Bagde 47 minutes later
Yes, XXXXXXX was on the metrodinazole and has not done a ph test, which shows at a normal range. However, she is still having abnormal discharge and similar infection manifestations. The original swab tested positive for yeast among other bacteria- which then spread to the anal area as well. I do not, however, think that she has a current yeast infection, but am at a loss as to how to respond going forward.
Yes, XXXXXXX was also on fluconazole as well, prior to the metrodinazole. Perhaps the best way to go, as you said, is to leave her alone for a couple of weeks and then see how things go. The blood sugar test is a good idea as well. Would that be ordered by her gynecologist or should I speak with her internist ? She just had a physical in XXXXXXX where blood work was done as a part of her exam. I can ask for the blood work results to review.

Thank you very much Dr. It is very helpful having someone else to speak with about this. We feel very lost with this situation.
Kind Regards,
XXXX
doctor
Answered by Dr. Madhuri N Bagde 32 minutes later
Brief Answer:
do not worry.

Detailed Answer:
Hello XXXX

Please go ahead and speak about the blood tests with the internists as well as the gynecologist. Also ask for the reports of the physical first as the sugar may already have been evaluated.

If it was a positive yeast earlier, now it may be a mixed infection. Even then better let it rest for atleast 7 days and then use mixed pessaries to be kept in the vagina alternating with lactobacillus pessaries to help restore the flora. Also wash the undergarments with hot water and change them twice daily till the infection clears as sometimes re contamination occurs from garments. Leaving the vulva open to air during night time also helps reduce growth of anerobic organisms and promotes healing. It also protects the area from moisture that may predispose to yeast infections. Also if she is sexually active then her partner must also be evaluated as sometimes these infections may be transmitted sexually.

So try these and let me know. I am always here for any more queries.

Take care. Hope she gets well soon. All my good wishes are with you.

Dr Madhuri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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