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Yeast Infections: When Should You Treat Yourself?

Posted Aug 24 2008 1:49pm
LISA CLARK: I'm Lisa Clark. Welcome, and thanks for joining us for this webcast. Our topic today is something that most women are, unfortunately, quite familiar with: yeast infections. It's estimated that 50% of college women in the U.S. have been diagnosed with at least one yeast infection by the age of 25. It's usually easy to treat, but it's very important to know how to recognize the symptoms and when you should consider a visit to your doctor.

Joining me to discuss this topic we have gynecologist Dr. Gloria Bachmann and Dr. Joseph Apuzzio. Thanks to both of you for joining me. Let's start with the basics. What exactly is a yeast infection?

JOSEPH APUZZIO, MD: A yeast infection is an overgrowth of yeast in the vagina severe enough to cause the patient to have symptoms.

LISA CLARK: So this is a naturally occurring yeast that's there all the time ,and it just gets out of control?

GLORIA BACHMANN, MD: Correct. Only when it overgrows does it become a problem or a vaginitis.

LISA CLARK: Let's talk about some of the very common causes, and there are a lot of them. Dr. Apuzzio?

JOSEPH APUZZIO, MD: I think first of all, diabetes. If the patient has diabetes, they're more prone to have yeast infections of the vagina. Also, if the patient is taking a steroid preparation for some medical illness, that also puts her at high risk. Antibiotics, patients who are taking antibiotics for a long period of time are also at high risk, because the antibiotic kind of suppresses the other flora in the vagina and allows the yeast to overgrow.

LISA CLARK: What about the pill? I understand that can be a cause sometimes.

JOSEPH APUZZIO, MD: Birth control pills in some patients may actually be a cause as well, so that certainly is the case.

LISA CLARK: Dr. Bachmann, there are a lot of environmental factors having to do with what women wear.

GLORIA BACHMANN, MD: That's right, lifestyle, if they wear tight-fitting jeans. Even toilet habits. Wiping from back to front rather than front to back is important. Wet bathing suits, all these things are really critical.

LISA CLARK: And douching has been considered problematic for some women.

JOSEPH APUZZIO, MD: Yes. What douching may do is actually kill off organisms in the vagina that suppress the growth of the yeast, so in essence, one should not douche unless they consult their doctor.

LISA CLARK: And it's also important to mention that HIV can be a contributing factor as well to recurrent yeast infections. Is that right?

JOSEPH APUZZIO, MD: Yes, that's correct. Any time the patient's immune system, their natural way of fighting off infections, is suppressed, such as a patient who has HIV, they can also get yeast infection.

LISA CLARK: Let's talk about what a woman notices when she's getting a yeast infection? What are some of the symptoms, for those who have not experienced one?

GLORIA BACHMANN, MD: Probably the most important symptom that a woman notices at the time that she's in the throes of it is itching, severe itching. She almost feels that she wants to scratch the skin away, it's so intense. Another is erythema, or redness, of the external area of the vagina. Cheesy discharge is another common complaint that women have. Burning, irritation, even intercourse pain are symptoms that women will report.

LISA CLARK: Now, are these symptoms the same for every woman that you have seen in your practice?

JOSEPH APUZZIO, MD: Well, I think the answer is yes, but there's variation. Some patients have more discharge. Other patients may have more itchiness of the vaginal area. But pretty much, the symptoms are alike.

LISA CLARK: If a woman has these symptoms that you've mentioned, does she definitely have a yeast infection, or could it be something else?

GLORIA BACHMANN, MD: Many times, women know that they have a vaginal yeast infection if they've been to their physician and know exactly what symptoms to expect with this infection. However, for women who are having the symptoms the first time, they should absolutely go to their physician, because these symptoms can mean any type of vaginal infection or vaginal inflammation -- for instance, trichomonas, bacterial vaginosis. These are all mimickers of yeast vaginitis.

LISA CLARK: So getting an accurate diagnosis, Dr. Apuzzio, is the first step? That's what you should do immediately?

JOSEPH APUZZIO, MD: Absolutely. It's really crucial. One should go to the doctor if they have the symptoms. The doctor can then do certain tests to see if the patient has yeasts that are causing the symptoms. One of the tests is a slide test where the doctor will take some secretions from the vaginal area, look at it under a microscope, and for the garden variety, so to speak, infection, one can see the yeast under the microscope that makes the diagnosis, and then the treatment can be specific.

LISA CLARK: And there's another test that you can do that's a yeast culture?

JOSEPH APUZZIO, MD: Well, one could also culture yeast from the vaginal secretions. But usually, patients who have the infection for the first time, one does not have to do that. The microscopic examination in the doctor's office where one sees the yeast under the microscope is really sufficient. Only in the more recurrent or resistant cases should one have a vaginal culture for yeast.

LISA CLARK: Do most doctors do this as a matter of course? If someone comes in with these complaints, do they do these cultures or these slides?

GLORIA BACHMANN, MD: Many times physicians will diagnose because of the symptoms that the patient comes in with, and I think it's really important for women to say, "Doctor, have you looked at the secretions to verify that I have a yeast infection?" I think it's a good dialogue on the part of the woman to ask the physician that indeed she or he has looked at the secretion and made a definitive diagnosis of yeast.

LISA CLARK: So let's say you get the right test, the results come back positive, you have a yeast infection-- What sorts of treatments might be undertaken at this point?

JOSEPH APUZZIO, MD: I think it depends on the patient's preference. One can give oral therapy or a vaginal cream or suppository to treat the yeast, either of which are about the same success rate, so it's not that one gives better success than the other.

LISA CLARK: In your practice, why do some women choose the pill over the cream or vice versa?

GLORIA BACHMANN, MD: There are actually two types of women, one type of woman who chooses the pill absolutely will use nothing in the vaginal area, that she feels it's an untouchable area and that she prefers the pill, whereas there are women who say, "I only want to treat the area that is infected or that has the infection, and therefore I want to put something there and know that it's working, rather than having something systemic."

LISA CLARK: Dr. Apuzzio, when should a woman consider treating herself? It's certainly easy to do. Any drugstore carries a number of these products.

JOSEPH APUZZIO, MD: A patient who has recurrent infection, where she knows it's recurrent because she's visited her doctor and he's made the diagnosis in the past with the microscope slide test, the wet prep, and also, potentially, a culture, those are patients who may then treat themselves because they know what they're dealing with. However, a patient should not treat herself if she hasn't had that kind of evaluation at least on one or two occasions by the doctor.

LISA CLARK: And if a woman has any doubts or concerns about what her symptoms may really be, even if she thinks this might be a yeast infection, she's had one before, what do you recommend?

GLORIA BACHMANN, MD: She should see her doctor. Absolutely, bottom line.

LISA CLARK: Well, thank you both for joining us. We appreciate your time. And thank you for joining us for our webcast. I'm Lisa Clark.

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