Yeast infections: Dangers of self diagnosis - HealthLINK (Women)

Yeast infections may require an office visit

The results of the study aren't very surprising to most physicians. We've known there's a potential for women to misdiagnose yeast infections and treat themselves with antifungals that may be expensive and ineffective. And there is a risk other infections may be missed, but these over-the-counter (OTC) medications do offer women convenience.

Women may misdiagnose yeast infections and treat themselves with antifungals that may be expensive and ineffective.

The benefit of having access to a product that can offer immediate relief from the irritating intense itching and other symptoms of yeast infections is significant. We have to balance that benefit with the possibility women will miss other problems.

There is also some concern that inappropriate use of antifungals will result in resistant strains of yeast infections. It may take a little longer to cure an infection, but we have not seen new strains that fail to respond to current medications.

Should you see your doctor?
Though itchiness is a main symptom of yeast infections, if you've never had one before, it's hard to be sure just what's causing your discomfort. After a doctor makes a diagnosis of vaginal yeast infection, if you should have one again, you can more easily recognize the symptoms that make it different from similar problems. If you have any doubts, though, you should contact your doctor.

The approach in our practice is to encourage women who have never had a clinically diagnosed yeast infection or women who have no predisposing factors such as recent antibiotic use to come into the office for a culture.

Symptoms of a yeast infection
Although yeast infections share symptoms with other infections, most women who have had yeast infections can recognize the characteristic thick, curdy, cheese-like discharge, intense itching, soreness and burning, especially during urination. It's important to remember that not all girls and women experience all of these symptoms, but if intense itching is not present, it's probably something else.

If a woman calls me and describes a nonspecific yellow discharge, I would want her to come into the office for an examination and laboratory tests. If a woman has taken a complete course of an over-the-counter antifungal medication and is still experiencing symptoms, I would also encourage her to come for an office visit. Other symptoms that should prompt a call to the doctor include:

Abdominal pain, fever or a foul-smelling discharge
No improvement within three days
Symptoms that recur within two months

In addition to OTC products, there is also a one-dose oral medication on the market called fluconazole, which is currently available by prescription only.

“Although untreated yeast infections do not pose a health hazard, other infections that could be misdiagnosed for a yeast infection might.”

Although untreated yeast infections do not pose a health hazard, other infections that could be misdiagnosed for a yeast infection might. The most common vaginal infection, bacterial vaginosis, can place a woman at higher risk of developing pelvic inflammatory disease. There is also a concern that pregnant women who have bacterial vaginosis are at risk of preterm labor, so it's particularly important for pregnant women to be properly diagnosed.

Causes of yeast infections
Yeast infections are basically disturbances in the vagina's ecosystem caused by a fungus called candida albicans. Candida occurs naturally, but when its growth becomes rapid and excessive, it can develop into an infection.

The vagina's normally acidic environment keeps yeast organisms from growing, but if the vagina becomes less acidic, yeast organisms may proliferate. The acidic balance of the vagina can be changed by some antibiotics, birth control pills, douching solutions, diabetes and pregnancy. Moisture and irritation of the vagina also seem to encourage yeast to grow. Though unusual, repeated yeast infections--especially if they don't clear up with proper treatment--may be the first sign of diabetes or HIV infection, the virus that causes AIDS.

Prevention tips
There are many things women can do to discourage yeast infections. The active cultures within yogurt are particularly effective in maintaining a healthy balance, and yogurt is a good food to add to your diet for its calcium as well as yeast-fighting attributes. Yogurt may help relieve some of the discomfort of an infection. You can put plain yogurt containing live cultures on your vulva or dip it into a tampon and insert it into your vagina. You can also get acidophilus capsules at a health food store and use them as a suppository. In addition:

Limit wearing of panty hose, tights, leggings, nylon underwear and tight jeans.
Don't use deodorant tampons and feminine deodorant sprays, especially if you feel an infection beginning.
Dry off quickly and thoroughly after bathing and swimming—don't stay in a wet swimsuit for hours.
Don't take any antibiotics unnecessarily.

Dr. Minkin is an attending gynecologist/obstetrician at Yale-New Haven Hospital and a clinical professor in obstetrics and gynecology at the Yale School of Medicine. She is a partner of the Gynecology and Infertility Group with offices in New Haven, Guilford and Essex.

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