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Yeast Infection or what??
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Aliss posted:
Background info: I am 26, married, never been pregnant, no health issues related to the reproductive system.

I've been having problems with recurring yeast infections and occasional BV for about 16 months. The treatments never seem to completely take it away. At this point, however, my doctor has tested my discharge twice in the last month and both times it has come up negative for a yeast infection, even though I have pain with urination and riding my bike, and especially sex, AND I have white, yeasty-smelling discharge.


Because of the recurring yeast infections and symptoms which persist even when tests show no infection, I've been tested for any abnormalities that can be detected in a standard PAP smear, STDs (and specifically HPV), and diabetes. Everything was completely normal. The only other factor I can think of was that I went off of birth control pills a couple months prior to when the infections started. I had previously been doing a continuous dosing method for 4-5 years and had been taking birth control pills since I was fifteen (10 years). I thought that might have effected my hormones and caused the infections, so I went back on the pill (not continuous dosing, though) about 3 months ago. No change since then.

I am currently living in Japan in a small town, and mine is the only English-speaking doctor nearby. He's nice, but not proactive. That's why I'm posting on here: if anyone has ideas that I can run by my doc, he will test for them and try any medication I ask for if it is available and reasonable.

The pain I always have with intercourse feels the same as when I have a yeast or bacterial infection, and the discharge I have every day looks and smells like a yeast infection, yet tests of my discharge samples are negative for yeast infections. Could the test repeatedly be wrong? What else could it be? What kinds of tests can I ask for? What other conditions can I suggest? I am going crazy here, depressed, desperate. It's been over a YEAR!!! Please help!
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Jane Harrison Hohner, RN, RNP responded:
Dear Aliss:There is a subgroup of women who have chronic and recurrent yeast infections. It is important to document that these infections are truly candida (yeast). Other conditions such as lactobacilli vaginitis (an overgrowth of the beneficial hydrogen peroxide producing lactobacilli) can masquerade as yeast, but yeast medications will NOT provide any lasting relief. Certain dermatologic conditions of the vulva can have symptoms which mimic yeast (eg lichen sclerosus), as can atrophic vaginitis (unlikely in a woman on birth control pills).

In your specific case it sounds like the vaginal wet mount test done under a microscope has been negative for yeast. If you are convinced that yeast may still be the culprit you can ask for a candida CULTURE. This will identify yeast (or none) and can give a subtype. About 80% of yeast is the common candida albicans. Other subtypes (eg glabrata) may respond less well to our usual yeast treatments. If a culture is negative then the search has to be widened for the cause of your symptoms.

Women with chronic yeast may be treated with a variety of options. A change of prescriptive yeast treatment may be tried. Preventative treatments may be used around the time of menses every month. Use of other medications which can predispose women to candida (eg steroids, chronic oral antibiotics, or even birth control pills) may need to be re-examined. Some healthcare providers will use treatments like vaginal boric acid capsules for either treatment or prevention in the cases of resistant vaginal yeast. There is even the suggestion that being the recipient of oral sex may predispose a woman to recurrent yeast (Reed, 2000).

Irritation of vaginal and vulvar tissues leading to pain with intercourse is less likely to be present with BV than with yeast or an overgrowth of lactobacilli. Alas, the malodorous BV can be recurrent. If that is your situation the first choice is to try an alternative form of prescriptive therapy. Some MDs will treat the male partners with a one time dose of Flagyl in an attempt to decrease the woman's re-occurrences. But the research studies of male partner treatment have not shown a distinct benefit.

Gosh, I'm sorry that it is so hard for you to access a second opinion. If things do not improve you may have to see another GYN in a nearby city.

In Support,
Jane


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