Introduction
Much misinformation circulates about genital yeast infection. Vaginal yeast infection is more common and also more difficult to treat. Hormone effects such as in pregnancy or a lack of hormones as in menopause tends to make this condition more chronic. Male yeast infection responds very quickly to topical therapy. In the following I shall deal with each item separately.
Vaginal Yeast Infection
The most common cause of vaginal yeast infections are following antibiotic therapy for a bacterial throat infection, ear infection or some other infection, which requires antibiotic therapy. The antibiotic diminishes the natural bacterial flora in the vagina. At the same time the lactic acid level from the lactobacillus in the vaginal secretions diminishes also leading to a changed milieu. This change is all that is required in order to allow Candida albicans, which is one of the natural inhabitants in the vaginal flora, to become aggressive and start invading the mucous membranes.
The result is an inflammation, which favors more yeast bug growth and infection. When there is a florid infection, which may only take a few days, there can be plaques of white matter attached to the mucous membrane of the vagina, which tells the physician already on inspection that the likely diagnosis is vaginal yeast infection. A swab will confirm the diagnosis in 1 to 3 days. Here is a picture of a diaper dermatitis in a baby girl, super infected with Candida albicans. Note the satellite lesions in the diaper area.
Note: This is not a form of venereal disease. Although it could be transmitted via sex, it is much more likely that this infection originates from within, but triggered by factors such as prior antibiotic therapy, birth control pill or pregnancy (hormone changes), weakness of the immune system by a prior viral illness or spontaneously with no identifiable cause. There seems to be a lot of needless finger pointing, when there is no evidence of that.
Genital Yeast Infection
Treatment of vaginitis
Treatment is similar as for yeast infections of the skin, except that nystatin is used in form of vaginal creams or vaginal inserts. If this does not lead to a successful cure, then clotrimazole ( brand name: Canesten) is used. Sometimes the vaginal yeast infection is difficult to control and an oral preparation of fluconazole (brand name: Diflucan) has to be used in a dosage of 100 to 200 mg daily for 1 or 2 weeks. The physician will want to keep an eye on liver function as some patients are more sensitive to this medication. However, this medicine has helped thousands of women with chronic recurrent yeast infections to achieve a lasting cure.
Male Yeast Infection
A yeast infection in the male typically affects the tip of the penis (the glans of the penis). In a man who was circumcised the foreskin covers the penis only partially. However, in a man who never had a circumcision the foreskin covers the glans of the penis. In this situation there is an increased likelihood to get a yeast infection of the very tender skin of the glans. The infection could come from a variety of factors. These factors could be internal (diabetes, antibiotic therapy, weak immune system with other illnesses) or it may come from exposure with sex to a woman who happens to have a yeast infection. In my medical experience it takes possibly a few days or weeks of exposure before a male gets a yeast infection by sex, in other words the contagiousness is not that high for a male.
The clinical diagnosis is that of a “balanitis”. This is the medical term for a red thickening of the glans of the penis with some satellite lesions around the reddened area. In advanced (neglected) cases there will be growth of whitish plaque (see this image), which under the microscope would be full of yeast threads and spores, a direct sign of Candida albicans.
Treatment of balanitis
Treatment consists of topical creams or ointments and responds usually within two to three days. Nystatin, Canesten or Loprox cream are all effective. Rarely would there be a need for systemic antifungal tablets such as ketoconazole (brand name: Nizoral)or fluconazole(brand name: Diflucan) (Ref. 3,p. 1334).
References
1.The Merck Manual, 7th edition, by M. H. Beer s et al., Whitehouse Station, N.J., 1999. Chapter 158.
2.The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 113.
3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 164.
4.David Heymann, MD, Editor: Control of Communicable Diseases Manual, 18th Edition, 2004, American Public Health Association.
