Brief Answer:
Both partners should be treated simultaneously : Diabetic control

Detailed Answer:
Dear XXXXX,

You are type 2 Diabetic person. Diabetes is a condition of immuno-suppression. So the body defence mechanism has gone to low level in diabetes. Thus diabetic persons are more prone for repeated infections.

What are your blood sugar levels? What medicines are you taking for controlling your diabetes? Coumadin is a medicine used for preventing blood clots. What is your anti-diabetic treatment?

What is your age? Are you a menopausal woman? After menopause, women do get repeated vaginal infections due to low Oestrogen rendering the vaginal skin thin and weak.

In spite of vaginal discharge you feel dryness. This happens in vaginal infections - fungal, trichomonal or bacterial. Bacterial vaginosis is treated with antibiotics, trichomonal by metronidazole while fungal with antifungal preparations. You have not mentioned which medicines you were given for treatment of vaginal infection. Will you please be rather descriptive and explicit in explaining your treatment modality? Also please explain me what type of discharge you have? Is it yellowish white and free flowing, greenish white which is frothy or curdy white? This can help me identifying the causative organisms and then I can suggest you remedy. It is a good idea to submit the vaginal swab for laboratory examination which can find out the causative organisms and the medicines to which they are sensitive.

Vaginal infections are usually sexually transmitted. Hence, it is advisable that the treatment is taken by both the sexual partners simultaneously. Along with the medical treatments, some practical tips are to be followed by both the partners. They are:

1. Clean shave the parts. Discharge painted in the hair causes reinfection.

2. Boil underwear daily.

3. Use panty liners (for you only).

4. Clip the nails short and avoid scratching.

5. Observe complete sexual abstinence till both of you are declared completely cured.

Along with the medicines, please use Lactobacilli vaginal ovules for inserting in the vagina twice a day. Lactobacilli perineal wash also is very useful.

Usually, the men do not exhibit the symptoms early and hence are reluctant to go for treatment; however, they do have infection on their private part which is responsible for relapse in women. Hence, please insist for your partner's treatment irrespective of the symptoms.

Povidon iodine vaginal pessaries are effective on all the three types of infections to some extent; however, since you are having repeated relapse, you might require specific medicines.

Please reply with the answers to the requested questions and upload the reports of the suggested investigations. Meanwhile, Lactobacilli perineal wash will give you substantial relief.

For any more information or advice, I am always available for you, XXXX. You may consider posting a good review with 5 start rating for me.

Dr. Nishikant Shrotri

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Brief Answer:
Antifungal medicines locally and Lactobacilli locally

Detailed Answer:
Dear XXXXX,

Thank you for some information you have provided. Let me address the issue of your white discharge (Leucorrhoea) first.

White curdy discharge is a fungal discharge. You have candidial or monalial vaginitis. It has to be treated with antifungal local medicines. Please use Candid locally. Alternatively you can get the vagina painted by Gentian violet which is very effective, however, very messy and stains the clothes and skin violet. As I have conveyed to you in my previous communication, please use Lactobacilli vaginal ovules or use Lactobacilli perineal wash like Lactacyd. It will give you speedy recovery and avoid recurrence. Continued use of such perineal wash is advisable.

This infection seems to be due to diabetes. I had informed you that in diabetes, the immunity goes low inviting many such infections and infestations. You feel your diabetes is under control. You have informed me the blood sugar levels; however it does not mention whether they are fasting of post prandial. Please specify. I would appreciate if you get your fasting and post-prandial values freshly done and inform me. It takes hardly few minutes for these tests by home Glucometer. You have to maintain fasting blood sugar under 105 mg% and post prandial blood sugar under 140 mg%.

Though you are observing sexual abstinence over last few weeks, you are having this problem over long period. So please request your partner also to apply candid ointment locally over the shaft and glans of penis and the skin around in the perineal area.

Please follow the hygienic tips I have given you in last communication. Commode is a common source of Fungal infection. Please maintain the cleanliness of your commode.

Night sweats do suggest the possibility of menopausal symptom. I would have appreciated had you shared your age with me. This is an additional factor for your vaginal fungal infection. However, first get the fungal infection treated. You may take your Gynaecologist's opinion for Menopausal syndrome; however, I would refrain from Hormone Replacement Therapy.

Please feel free to ask me for any more advice or Information, XXXXXX.

Dr. Nishikant Shrotri

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Brief Answer:
Do not ignore fungal infection

Detailed Answer:
Dear XXXXX,

Unless you inform me about your fasting and post-prandial blood sugar levels, I will not be able to say about your dosage of Metformin. In fact, better is blood Glycated HbA levels. Please get it done ASAP and upload the reports for my view. Then only I will tell you about the dosage required for you. Good that you are working on your diet. Along with start exercises. Everyday walk with pace of 90 steps/min for 40 minutes twice a day is good for diabetes.

Estrace is Oestrogen cream which is given to build the vaginal skin, which in Menopause has become too thin inviting many infections. It is safe to use it. It will not worsen the yeast infection. However, after antibiotics treatment, the yeast infection will get worsened. Hence, start the anti-fungal treatment and then start antibiotics. In fact I do not understand why antibiotics has been prescribed to you? Will you please clarify? It is not routinely prescribed along with Estrace unless coexisting bacterial infection. What is the indication of starting antibiotics?

From your history, I could not find any anti-fungal medicine You need it very badly, with local Lactobacilli preparation. Please do not delay it.

I would appreciate your reports ASAP.

Dr. Nishikant Shrotri

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