Vaginal yeast infections (also called yeast vaginitis or vaginal candidiasis) are a common problem in

women. The most common symptoms are itching and irritation of the vulva and around the opening of the
vagina. Vaginal yeast infections usually occur as infrequent episodes, but can recur frequently and may
cause chronic persistent symptoms.

Yeast infections occur mainly in women who are menstruating (having monthly periods). They are less
common in postmenopausal women who do not use estrogen-containing hormone therapy and they are
rare in girls who have not yet started menstruating.

VAGINAL YEAST INFECTION SYMPTOMS

The most common symptoms of a yeast infection include:

Itching or irritation of the vulva and around the vaginal opening

Pain with urination, vulvar soreness or irritation,

Pain with intercourse

Reddened and swollen vulvar and vaginal tissues.

Some women have no abnormal vaginal discharge.

Others have white clumpy (curd-like) or watery vaginal discharge.

Symptoms of a yeast infection are similar to a number of other conditions, including bacterial vaginosis (a
bacterial infection of the vagina), trichomoniasis (a sexually transmitted infection), and dermatitis (irritated
skin). (See "Patient education: Vaginal discharge in adult women (Beyond the Basics)".)

It is often not possible to know if itching is caused by yeast or other causes.

VAGINAL YEAST INFECTION CAUSE

The fungus that causes yeast infections (named Candida) normally lives in the gastrointestinal tract and
sometimes the vagina. Normally, Candida causes no symptoms. However, when there are changes in the
normal flora of the gastrointestinal tract and vagina (caused by medicines, injury, or stress to the immune
system), Candida can overgrow and cause the symptoms described above.

VAGINAL YEAST INFECTION RISK FACTORS

In most women, there is no underlying health problem that leads to a yeast infection. There are several
risk factors that may increase the chances of developing an infection, including:

Antibiotics Most antibiotics kill a wide variety of bacteria, including those that normally live in the
vagina. These bacteria protect the vagina from the overgrowth of yeast. Some women are prone to
yeast infections while taking antibiotics.
 Hormonal contraceptives (eg, birth control pills, patch, and vaginal ring) The risk of yeast
infections may be higher in women who use birth control methods containing estrogen.
(See "Patient education: Hormonal methods of birth control (Beyond the Basics)".)
Contraceptive devices Vaginal sponges, diaphragms, and intrauterine devices (IUDs) may
increase the risk of yeast infections. Spermicides do not usually cause yeast infections, although
they can cause you to have vaginal or vulvar irritation. (See "Patient education: Birth control; which
method is right for me? (Beyond the Basics)".)
Weakened immune system Yeast infections are more common in people who have a weakened
immune system due to HIV or use of certain medications (steroids, chemotherapy, post-organ
transplant medications).
Pregnancy Vaginal discharge becomes more noticeable during pregnancy, although yeast
infection is not always the cause. (See "Patient education: Vaginal discharge in adult women
(Beyond the Basics)".)
Diabetes Women with diabetes are at higher risk for yeast infections, especially if blood sugar
levels are often higher than normal.
Sexual activity Vaginal yeast infections are not a sexually transmitted infection. They can occur in
women who have never been sexually active, but are more common in women who are sexually
active.

VAGINAL YEAST INFECTION DIAGNOSIS

Yeast infections can be diagnosed with an exam. During the exam, your doctor or nurse will examine your
vulva and vagina and swab the vagina to get a sample of discharge. Do not begin treatment at home
before being examined.

Self-diagnosis Women with vulvar itching or vaginal discharge often assume that their symptoms are
caused by a yeast infection and then use a non-prescription treatment. However, in one study, only 11
percent of women accurately diagnosed their infection; women with a previous yeast infection were only
slightly more accurate (35 percent correct) [1].

Diagnosing and treating yourself:

Wastes money (on non-prescription treatment)

Wastes time; you will not feel better until you use the right treatment
Can make you more itchy and irritated

RECURRENT VAGINAL YEAST INFECTIONS

Between 5 and 8 percent of women have recurrent yeast infections, defined as more than four infections
per year.

Diagnosis As with initial yeast infections, it is important to correctly diagnose recurrent yeast
infections. A woman who has frequent signs and symptoms of vulvar or vaginal irritation or itching should
be seen by a healthcare provider to ensure that her symptoms are caused by yeast rather than other
common problems (eg, other vaginal infections, allergic reaction or sensitivity, eczema). As with initial
infections, self-diagnosis is not accurate enough to recommend treatment.

Most vaginal yeast infections are caused by Candida albicans. Persistent or recurrent infections may be
due to infection with one of the less common species of Candida, such as Candida glabrata or Candida
krusei. In women with recurrent or persistent symptoms, vaginal cultures should always be obtained to
confirm the diagnosis and identify these less common species, if present, since different medications are
used to treat these infections.

Treatment Women with recurrent infections are usually given a longer course of treatment for
infections, between 7 and 14 days for a topical (cream or suppository) medication or fluconazole 150 mg
by mouth with a second and third dose 3 and 6 days later.

Preventive treatment may be recommended after the infection has resolved; this may include fluconazole
(150 mg orally once per week) or clotrimazole (500 mg vaginal suppositories administered once per
week).

Treatment of a sexual partner Vaginal yeast infections are not a sexually transmitted infection,
although the infection may rarely be passed from one partner to another. Experts do not recommend
treatment of a sexual partner.

PREVENTION

Sporadic attacks of vulvovaginal candidiasis usually occur without an identifiable precipitating factor.
Nevertheless, a number of factors predispose to symptomatic infection:

Diabetes mellitus Women with diabetes mellitus who have poor glycemic control are more prone
to vulvovaginal candidiasis than euglycemic women. Maintaining good glycemic control can help to
prevent vaginal infection.
Antibiotics One-quarter to one-third of women are prone to vulvovaginal candidiasis during or
after taking broad spectrum antibiotics. These drugs inhibit normal bacterial flora, which favors
growth of potential pathogens such as candida. In women susceptible to symptomatic yeast
infections with antibiotic therapy, a dose of fluconazole (150 mg orally) at the start and end of
antibiotic therapy may prevent postantibiotic vulvovaginitis.
Increased estrogen levels Vulvovaginal candidiasis appears to occur more often in the setting of
increased estrogen levels, such as oral contraceptive use (especially when estrogen dose is high),
pregnancy, and estrogen therapy, including topical or intravaginal estrogen therapy by
postmenopausal women.
Immunosuppression Candidal infections are more common in immunosuppressed patients, such
as those taking corticosteroids or with HIV infection.
Contraceptive devices Vaginal sponges, diaphragms, and intrauterine devices have been
associated with vulvovaginal candidiasis, but not consistently. Spermicides are not associated with
candida infection.
Behavioral factors Vulvovaginal candidiasis is not traditionally considered a sexually transmitted
disease since it occurs in celibate women and since candida is considered part of the normal vaginal
flora. This does not mean that sexual transmission of candida does not occur or that vulvovaginal
 candidiasis is not associated with sexual activity. As an example, there is an increase in the
frequency of vulvovaginal candidiasis at the time most women begin regular sexual activity. Partners
of infected women are four times more likely to be colonized than partners of uninfected women,
and colonization is often the same strain in both partners. Individual episodes of vulvovaginal
candidiasis do not appear to be related to lifetime numbers of sexual partners or the frequency of
coitus, but may be linked to orogenital and, less commonly, anogenital sex.

There is no good evidence showing a link between vulvovaginal candidiasis and hygienic habits or
wearing tight or synthetic clothing.

SUMMARY

Vaginal yeast infections are a common problem in women.

Itching is the most common symptom of a vaginal yeast infection. Women may also note pain with
urination, soreness or irritation, pain with intercourse, or reddened and swollen vulvar and vaginal
tissues. There is often little or no vaginal discharge; if present, discharge is typically white and
clumpy (curd-like) or thin and watery.
Symptoms of a yeast infection are similar to a number of other conditions. A physical examination
and laboratory testing are needed to determine the cause of symptoms.
There are several risk factors that may increase the chances of developing a yeast infection,
including use of antibiotics, birth control, diabetes, pregnancy, and a weakened immune system (due
to chemotherapy, HIV, or certain medications).
To diagnose a vaginal yeast infection, a healthcare provider will do an examination. It is important
to be seen and tested when symptoms are bothersome and before any treatment is used.
Do not begin treatment for a yeast infection before being examined and tested.
Treatment of vaginal yeast infection may include a vaginal cream or tablet or a pill taken by mouth.

Epithelial atrophy of the vagina can be treated by the oral or vaginal

administration of estriol, but according to the Consensus Statement on
Menopausal Hormone Therapy, local therapy with low-dose estrogen is
preferred for women whose symptoms are limited to vaginal dryness or
associated discomfort with intercourse [11]. However, estrogen is readily
absorbed through the vaginal wall [10], leading to similar systemic effects as
would be produced by oral therapy with a 1020 fold greater dose [12].
Fortunately, only very small dosages are needed to treat vaginal symptoms, and
low-potency estrogens like estriol (E3) can readily be used with only limited
systemic effects in spite of absorption [10].
Itraconazole
Take this medication by mouth with a full meal as directed by your doctor, usually once
or twice daily. Swallow the capsules whole.

Take itraconazole 2 hours before or 1 hour after antacids. Antacids may decrease the
absorption of this medication. Also, take this medication with an acidic drink...