Genital
Yeast InfectionIntroduction: Much
misinformation circulates about this disease. Vaginal yeast infection is more
common and also more difficult to treat. Hormone effects such as in preganancy
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 natural bacterial flora in the vagina gets diminished
as a side effect and the lactic acid level from the lactobacillus gets diminished
leading to a changed milieu in the vaginal secretions. This change is all that
is required in order to allow Candida
albicans (microscopic picture), 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, superinfected 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. Therapy: 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 In the male the yeast infection
is usually confined to the tip of the penis (the glans of the penis). In a circumcised
man this is not covered (or only partially covered) by the foreskin. In an uncircumcised
man this area is covered by the foreskin and 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:
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). |
