Dear An: You are correct, it is unlikely that BV is the cause of the extreme irritation (pain & burning). It also sounds like you got no relief from the creams, longer course of Difulcan or the oral steroids.
Frequent "yeast infections" that do not respond to any of the prescribed treatments suggest a couple of POSSIBILITIES. First that yeast is not the culprit, or second that it is one of the atypical subtypes of yeast ("candida").
The easiest way to help unravel this question is to have the GYN do a yeast CULTURE the next time.If the culture is negative then yeast is not the cause. Some other conditions which can produce yeast type symptoms include:
1. Cytolytic vaginitis--this is an overgrowth of the beneficial, hydrogen peroxide producing lactobacili that help keep the vagina clear of undesirable bacteria. An overgrowth can produce an itchy, burning, irritating discharge.
2. Desquamative vaginitis--this causes irritation and a discharge. Under the microscope there are many immature vaginal skin cells (can look like atrophic vaginitis) and lots of white blood cells.. Originally treated with clindamycin, more currently it is thought to be an autoimmune condition liked to lichen planus.
3. Lichen sclerosus--this is a skin condition outside the vagina (usually between the vaginal opening and the anus) that can create intense itching and irritation.
4. Contact dermatitis--this would be from a change in tampons/pads, new bubble bath, etc. I would doubt this is your problem as you have already switched products.
If the yeast culture
is positive, then the lab can identify which of the yeast subtypes may be the villain. Most of our yeast medications are developed for candida albicans --about 80% of yeast infections are due to this. The other 20% or so are uncommon subtypes (eg candid glabrata). To treat the less common subtypes clinicians may try boric acid vaginally or even painting with a gentian violet (very messy!).
Yours,
Jane