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Summary:

Yeast infections are fungal infections that are treated with antifungals. They're also called candida infections.
Symptoms include: burning, irritation, sometimes itching with a cottage cheese discharge.
Check the strain and susceptibility with your doctor to make sure the drugs being used will work, especially if you get them frequently (see “Repeated yeast infections” section).

Intro

A yeast infection, also known as a candida infection, is a common condition caused by a fungus.

 

Infections can take place in the mouth or anywhere on the skin but for women it often takes hold in the vagina.

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Candida grows best in warm moist areas and so pathological overgrowth occurs when the microbiome of the vagina becomes unbalanced.

 

Candida is most often a commensal organism, that means it lives in the body without causing problems unless conditions allow it to replicate excessively.

 

“Candida exists without causing symptoms in about 20 to 50% of healthy women”

Candida exists without causing symptoms in about 20 to 50% of healthy women (McClelland RS, et al. 2009 referenced in Konolad 2019). That means it lives in the vaginal microbiome without causing harm and doesn't necessarily always need to be treated despite being identified on a swab.

 

Vaginal Yeast Infections

It is unknown why the vaginal mucosa is particularly susceptible to candida overgrowth and more research is needed in this area.

 

“Less than 1% of worldwide health funds are spent on women's health”

 

Less than 1% of worldwide health funds are spent on women's health and our understanding (or lack of it) is linked to gender inequalities in medicine.

Yeast Infection Strains

90% of infections are caused by the Candida albicans strain. However infections can also be caused by: Candida parapsilosis, Candida glabrata, Candida dublinensis, Candida tropicalis, Candida krusei and Saccharomyces cerevisiae.

A new species, Candida auris, has also been detected but is more associated with systemic infections than vaginal infections and is multiple drug resistant.

 

Yeast Infection Treatment

 

Candida albicans usually responds to azole drugs like fluconazole and clotrimazole. However if you have repeated infections, it can eventually develop resistance and may need to be treated with second-line therapies like boric acid suppositories, nystatin or itraconazole.

 

“Non-albicans strains are more azole resistant”

 

Non-albicans strains are more azole resistant and require long-term treatment with second-line drugs like nystatin or boric acid. A new drug released in America, Brexafemme, is also an oral medication that can be used in azole-resistant cases. The licence is owned by GSK and may not be eligible for release in Europe for a number of years – watch this space.

 

Whilst evidence for probiotics to combat a yeast infection is mixed, consumption of lactobacilli strains has been associated with an increase in protective bacteria that usually keep candida numbers in check (Zahedifard 2023). This must be in combination with antifungal treatment, and probiotics alone will not treat a candida infection.

 

Symptoms

Different women experience symptoms differently and to varying degrees of irritation. However key symptoms are as follows:

 

– Raw burning in the vulva

– Intense burning in the vagina

– White cottage cheese discharge (although this can be absent)

– Itching in the vulvovaginal region

 

Risk Factors

 

Environmental changes that allow candida overgrowth include:

 

Antibiotic use – by killing off lactobacilli, Candida has no competition for sugars and can easily overgrow.

 

High sugar diet – eating foods and drinks filled with simple sugars like sweets, chocolate, fizzy drinks and alcohol over a sustained period allows for candida overgrowth. People who suffer from diabetes are at increased risk due to more freely available sugar in the blood.

 

Immune system compromise – this can be brought on by sustained psychological stress or having a break after an intense work period. HIV/AIDS patients have a higher risk of candida infection. Alcohol consumption also increases your risk of yeast infections.

 

Contraceptive use – the coil (both hormonal and copper) is associated with an increased risk of yeast infections as they allow biofilm formation and the microbe to evade the immune system. Contraceptives that increase levels of oestrogen have also been found to increase the risk of yeast infections as oestrogen allows sugar deposits in the vaginal wall.

 

Lifestyle factors – many mainstream lubricants contain glycerine, a sugar which increases the risk of yeast infections. Women should use brands without sugar like YES, which contain no added sugar. Douching, bubble baths/soaks and feminine products are associated with decreased numbers of lactobacilli which keep candida numbers in check. Certain clothes promote moisture in the vagina, which encourages candida growth. Cotton underwear and loose-fitting garments help prevent overgrowth.

 

Male Partners

Women with vaginal yeast infections can often pass the infection on to partners.

Men should be treated if symptomatic to ensure couples don't pass the infection back and forth to one another.