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Saturday, October 22, 2011

Rip-Roaring Vaginitis

An Old Professor Used to Say...
When I was in medical school at the Medical College of Virginia back in the day, there was an old professor (he was old then, and he's still out there on the lecture circuit even now!) who used to like to talk about what happens when women get out to the beach in the summer, cavort in the sand (his words, not mine), drink beer, etc....they would inevitably develop what he called "rip-roarin' vaginitis"...how quaint.  He was right though.  As I spend time for the next few months in a warm, sandy-filled environment (Kuwait), I will likely see more and more of what I have already agreed constitutes "rip-roarin' vaginitis."

Yeast infections of the vagina and the outer skin (vulva) are common regardless of whether or not you are at the beach, but there are certain things that can make these pesky, itchy outbreaks even more frequent.  Yeast, a fungal organism, is different from bacteria.  In fact, one of the risks for developing yeast vaginitis is being on an antibiotic for treatment of a bacterial infection.  Antibiotic medications actually kill off the type of vaginal bacteria that will prevent overgrowth of fungus (lactobacilli).  So it is not unusual for someone taking, say, minocycline for their facial acne, to always have symptoms of a yeast infection.

In addition to antibiotics, certain other medications and conditions are known to increase the potential of getting a yeast infection of the vagina and vulva.  This includes hormone therapies like birth control pills because estrogen has an effect on the vaginal wall cells that causes the cells to store more sugar - a known yeast magnet.  For a similar reason, uncontrolled diabetes can drastically increase the number of episodes of infection.

The classic symptoms include itching and/or burning sensation on the skin along with a fairly copious vaginal discharge that typically has no odor.  If there is associated burning with urination, it is usually going to be burning on the skin that surrounds the urethra (where the bladder empties out) as opposed to the lower abdomen - that type of burning pain is more associated with an actual bladder infection.  But sometimes the burning is hard to pin down, and women just know that it hurts somewhere down there...it's up to the doc to figure it out.

Because the symptoms of yeast vaginitis can mimic other skin conditions, an exam is important at least once in a while to confirm that the fungal organisms are actually causing the problem.  Trichomonas, a protozoan organism (similar to bacteria), causes the very same symptoms of itching/burning and discharge, but the treatment is far different from that of a simple yeast infection.  A specific antibiotic must be prescribed to kill the trichomonads, and any sexual partner must also be treated to avoid receiving the infection right back after therapy.  For yeast infections, there is no reason to treat the sexual partner.  Occasionally, an uncircumcised man can trap yeast beneath the foreskin and cause recurrent yeast infections in his partner, but that is uncommon.

The examination consists of a basic pelvic assessment using a speculum in the vagina to swab a bit of the discharge and view it under the microscope.  If yeast is present, the slide will have numerous hair-like strands of yeast with tiny buds protruding from the surface.  The skin of the vulvar can be very inflamed and have a spreading rash or even cracks in the skin from the itching and irritation over time....hence the term "rip-roaring" vaginitis.

Treatment is simple in most cases, but some people have a strain of yeast that is resistent to the usual therapies of Monistat Cream or Diflucan pills.  In those difficult situations, an actual culture to find out the strain of yeast and sensitivities to various antifungal medications could be helpful.  I have seldom had to resort to a culture because I have found that most yeast infections will resolve in due time if the patient and doctor have the determination to treat aggressively and for a long enough period of time.  This can take weeks in severe cases.  Prophylactic treatment while a person is taking antibiotics for some other condition can help prevent a terrible outbreak in people who are known to be susceptible to yeast.  So before you take that antibiotic or birth control pill and head out to the beach, you might want to have a chat with your doctor about how to recognize and thwart a rip-roarin' vaginitis of your own.

1 comment:

  1. I like your post. It is good to see you verbalize from the heart and clarity on this important subject can be easily observed.
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