About me: My name is Sarah Warren. I am a current biological sciences graduate student at Western Illinois University. I received my undergraduate degree at WIU in Biology with an emphasis on medical science in 2014. My current graduate studies are focused on the abundance and presence of the tick population in forested areas and determining the effects of prescribed prairie burning on their distribution and abundance. Aside from my research my scholastic focus is on medically important courses. Currently I am in a medical mycology class that describes the importance of fungi and their medical implications.

Vaginal Yeast Infections

Candida albicans

http://www.health.com/health/yeast-infection/

What is a Vaginal Yeast Infection and where does it come from?

Yeast infections are among the most common ailments in the female genital tract (1). Our body naturally harbors bacteria and fungi as a part of our normal flora. It helps keep our body functioning through symbiotic relationships. However, like any relationship, nothing is perfect. Due to imbalances and other factors that will be discussed later, the balance of bacterial and fungal growth can be shifted, allowing infection to occur. 

            Vaginal yeast infections will occur in 75% of women during their reproductive age and nearly 80% of these yeast infections will be caused by the over growth of the yeast Candida albicans (2).  C. albicans is a fungal species that is found in and on the human body naturally occurring in the vagina, mouth, digestive tract, and skin (2). Due to the dark, moist, warm features of the vagina, it is a breeding ground for Candida to grow and thrive (5).  Our body naturally accounts for this through a control system that consists of both bacterial “warriors” that keep fungal growth at bay and natural features of the body such as maintaining the vagina at a slightly acidic pH to discourage fungal over growth. However, this balance is easily shifted and can fail at self-protection from a fungal infection. When this occurs a woman may experience a yeast infection.

So what is a yeast cell and what does it have to do with an infection?

  Yeast is a unicellular organism classified as a fungus and is commonly found in the phylum Ascomycota (16). Candida albicans is the leading yeast species in vaginal yeast infections. Yeast cells are diploid and reproduce asexually (16). There is no known sexual reproductive stage of C. albicans (16). Asexual reproduction occurs through a process known as budding, in which a mother cell divides to create a second, daughter, yeast cell (16). Additionally, Candida can go through a process called morphogenesis that allows it to develop into germ tubes called hyphae or pseudohyphae (16).

  When a women’s vaginal homeostasis is altered, yeast that was previously at a controlled level can multiply without restraints classifying it as an opportunistic pathogen (16). This allows the controlled levels of present yeast in the vagina to multiple and change from its harmless yeast form into its hyphal form permitting the penetration into cell causing the irritating infection (3).

 

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What Causes a Vaginal Yeast Infection?

            Many factors can cause a shift in the balance maintaining the fungal growth within the vagina including both internal and external factors.

Internal Factors:

1.    The Use of Antibiotics:  By using antibiotics, the bacterial community is decreased or killed off in the process of eliminating a bacterial infection (8). The body’s normal bacterial flora decreases in the presence of antibiotics eliminating the essential competition that maintains the level of yeast present. When it is depleted, yeast is able to grow unchecked and cause infections.
2.    Use of birth control pills or other contraceptives: Hormonal balance plays a large role in maintaining a controlled yeast level within the vagina and using contraceptives alters the hormonal balance possibly creating an environment that yeast can thrive in.
3.    Menstruation: it has been recorded that many women receive yeast infections the week leading to or after a menstruation due to the changes in hormones present. If this occurs you may be considered to have chronic yeast infections (9)
4.    Diabetes: the altered presence of blood sugar in diabetic individual is like candy for yeast. It sets up a “sweet environment” that yeast tends to thrive in which increases an individual’s risk at contracting a yeast infection (11).

Physical Factors:

            Physical factors that increase the risk of contracting a yeast infection are mainly due to creating an ideal environment for the yeast to thrive and grow in. Wearing tight clothing or clothes that do not breathe well allows moisture to be retained in the vagina creating a moist environment for the yeast to thrive in. Another factor that plays a large role in yeast growth is diet (9). Diets that are heavy in sugars and carbohydrates increase the ability of yeast to thrive and grow within the vagina (5).

Sex plays a large role in contracting a yeast infection. Yeast cells can be transmitted from one individual to another during intercourse and greatly increases the risk of vaginal infections. However, due to the ability to contract a yeast infection without sexual activity restricts it from being considered a sexually transmitted disease (9).

Do I have a Yeast Infection? – Symptoms

One tell-tale sign of a yeast infection is the presence of itch occurring in the vaginal region. This itch may also be accompanied by (12):

·      Burning during urination

·      Vaginal discharge, white cottage cheese appearance

·      Pain during intercourse

·      Swollen red vulvar region

Stop! Why not to self-diagnosis yeast infections

According to a study at the Medical College of Georgia, the rate of women accurately self-diagnosing themselves with a vaginal yeast infection is only 1 out of 3 times (6). Yeast infections have similar symptoms to diseases such as bacterial vaginosis, trichomoniasis or a simple vaginal irritation (6). Misdiagnosis can lead to many other health implications such as pelvic inflammatory disease, infertility, and miscarriage (if the disease occurs during pregnancy) (6). Due to the similarity in symptoms it is always good to contact a doctor when a yeast infection is in question.

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In some cases a yeast infection may not be as straight forward to diagnosis even for doctors.

Case study 1 – College Student Suffering from Chronic Yeast Infections: Disseminated Yeast

A college student at Boston College was displaying symptoms including mild vaginal itching and slight discharge. She was diagnosed with a yeast infection by her doctor and put on a regimen of a topical cream. Her symptoms we relieved at first however they reoccurred shortly and started having other fungal infections such as athlete’s foot and skin rashes. Along with the physical inconvenience of fungal infections, she was also feeling fatigued all the time. After seeing multiple physicians, being treated for many different disorders that only seemed to make the situation worse, she was diagnoses with a systemic yeast infection caused by Candida albicans. The yeast that had originally caused chronic vaginal yeast infections was misdiagnosed as a simple yeast infection, allowed it to grow, develop, and spread throughout her body. After her final diagnosis, she was placed on anti fungals for yeast infections and the itching stopped. However she still has chronic yeast infections due to the high levels of yeast present in her body (4).

Case study 2- Adult Woman Suffering from Chronic Yeast Infections: HIV indicator

           A 32-year-old woman has been dealing with chronic reoccurring yeast infections for the past three years. Antifungal creams only seemed to give her temporary relieve. In her first visit to a physician she tested positive for a yeast infection and again was put on an antifungal. Yet again temporary relief occurred only to result in the return of a constant itch in her vaginal region.

            Going to a second physician, she was diagnosed with a bacterial infection and prescribed a triple-sulfa cream. Yet again the prescription only provided temporary relief and she was no experiencing painful intercourse and was feeling hopeless that the itch would never go away.

            Patient history revealed that both of her parents had adult onset diabetes and her boyfriend was a chronic drug user.  In her next visit to the physician, she was tested for several STDs and had her blood glucose level checked. All of her tests came back negative but was again tested positive for yeast and put back on an over the counter antifungal. A month later her symptoms worsened including a reddened appearance around the vulva and it extended down to the upper thigh. Additional testing was taken and tested positive for HIV.  To treat her chronic yeast infections she was placed on nystatin vaginal suppositories for 14 days and instructed to take a boric acid douche twice a week. (7).

Treatment and Prevention of Vaginal Yeast Infections

Yeast infections are never fun to deal with and sadly, after one occurrence you are more likely to have yeast infections and each additional infection is harder to treat (15).

Prevention:

·      Wearing loose clothing

·      Not wearing wet bathing suits

·      Daily washing (do not use normal soaps as they may disrupt the bacterial community and pH balance. Additionally using antibacterial soaps can cause even more damage as they eliminate the competition.)

·      Consumption of yogurt – Consumption of yogurt at least once every day for six months decreases the risk of contracting a yeast infection greatly (13)

Treatment:

            Today, women can pick up over the counter products that have active ingredients such as butoconazole nitrate, clotrimazole or miconazole that effectively cure vaginal yeast infections (9). They can either come in the form of topical treatments or insertions that are implanted into the vagina (9). 

Can women use antifungals during pregnancy?

Pregnancy commonly causes an increase in risk to contracting a yeast infection. Common over the counter medications are safe to use during pregnancy to cure a yeast infection (14). However it is strongly advised that you consult a physician before using them and also receiving a complete diagnosis to ensure that it is a yeast infection causing the symptoms.

I Commonly Get Yeast Infections- What is my body telling me?

Chronic yeast infections can often be a symptom for other more serious health complications (10).

·      Diabetes: A stubborn hard to treat yeast infection is often the first symptom of diagnosing diabetics (11).

·      Learning Disabilities: A chronic yeast infection present in children is often a sign of hyperactivity or learning disabilities developing (3). At a young age for children it is hard to diagnosis learning disabilities such as ADD or hyperactivity and in some cases the presence of chronic yeast infections may be the first sign to a child with learning disabilities. 

·      HIV: Women that suffer from frequent cases of yeast infections may be an early warning sign of an HIV infection (10). HIV is a disease that lowers the body’s ability to fight off diseases as it lowers the immune system. This allows for the ease of growth and contraction of yeast infections. It has been noted that that women who contract chronic yeast infections is not a symptom of HIV, However 38% women that are HIV positive suffer from chronic yeast infections (10).

References:

1.     Erdem H, Cetin M, Timuroglu T, Cetin A, Yanar O, Pahsa A. Identification of yeasts in public hospital primary care patients with or without clinical vaginitis. Australian & New Zealand Journal Of Obstetrics & Gynaecology [serial online]. August 2003;43(4):312-316. Available from: Academic Search Complete, Ipswich, MA. Accessed April 14, 2015.

2.     New A. Controlling `yeast' infections. FDA Consumer [serial online]. December 1993;27(10):10. Available from: Health Source - Consumer Edition, Ipswich, MA. Accessed April 14, 2015.

3.     DeMarco C. Take charge of yeast infections. Alive: Canada's Natural Health & Wellness Magazine [serial online]. January 2004;(255):88-91. Available from: Consumer Health Complete - EBSCOhost, Ipswich, MA. Accessed April 14, 2015.

4.     Merewood A. Taming the yeast beast. Women's Sports & Fitness [serial online]. November 1994;16(8):67. Available from: MasterFILE Premier, Ipswich, MA. Accessed April 14, 2015.

5.     Drury K. beauty & the yeast. Vegetarian Times [serial online]. July 2000;(275):24. Available from: Health Source - Consumer Edition, Ipswich, MA. Accessed April 14, 2015.

6.     Colino S. IS IT JUST A YEAST INFECTION?. Redbook [serial online]. January 2005;204(1):82. Available from: MasterFILE Premier, Ipswich, MA. Accessed April 14, 2015.

7.     Hutchins Jr. F. Just another yeast infection. Cortlandt Forum [serial online]. August 25, 1996;9(8):203. Available from: MasterFILE Premier, Ipswich, MA. Accessed April 14, 2015.

8.     Nicholson C. Why am I still getting yeast infections?. Harvard Women's Health Watch [serial online]. June 2005;12(10):8. Available from: Academic Search Complete, Ipswich, MA. Accessed April 14, 2015.

9.     Willis J. On the teen scene: an itch like no other. FDA Consumer [serial online]. April 1996;30:24-26. Available from: Readers' Guide Abstracts (H.W. Wilson), Ipswich, MA. Accessed April 14, 2015.

10.  Yeast infections may be early warning sign of HIV infection. Nation's Health [serial online]. January 1993;23(1):14. Available from: Health Source - Consumer Edition, Ipswich, MA. Accessed April 14, 2015.

11.  Von Wartburg L. Women, Sex, and Diabetes. Diabetes Health [serial online]. February 2007;16(1):48-49. Available from: Academic Search Complete, Ipswich, MA. Accessed April 14, 2015.

12.  Kohnle D. Health Tip: Symptoms of Yeast Infection. HealthDay Consumer News Service [serial online]. May 18, 2007:Available from: Consumer Health Complete - EBSCOhost, Ipswich, MA. Accessed April 14, 2015.

13.  The yogurt-yeast infection connection. Tufts University Diet & Nutrition Letter [serial online]. May 1992;10(3):1. Available from: Agricola, Ipswich, MA. Accessed April 14, 2015.

14.  Soong D, Einarson A. Vaginal yeast infections during pregnancy. Canadian Family Physician [serial online]. March 2009;55(3):255-256. Available from: CINAHL Complete, Ipswich, MA. Accessed April 14, 2015.

15.  Anonymous. Stubborn vaginal yeast infections. Africa Women & Health [serial online]. July 1994;2(3):5-8. Available from: Women's Studies International, Ipswich, MA. Accessed April 14, 2015.

16. Reiss, Errol, H. Jean. Shadomy, and G. Marshall. Lyon. Fundamental Medical Mycology. Hoboken, NJ: John Wiley & Sons, 2012. Print.

17. Sun, Lingmei, Kai Liao, and Dayong Wang. "Effects Of Magnolol And Honokiol On Adhesion, Yeast-Hyphal Transition, And Formation Of Biofilm By Candida Albicans." Plos ONE 10.2 (2015): 1-20. Academic Search Complete. Web. 28 Apr. 2015.

18. Vediyappan, Govindsamy, et al. "Gymnemic Acids Inhibit Hyphal Growth And Virulence In Candida Albicans." Plos ONE 8.9 (2013): 1-11.Academic Search Complete. Web. 28 Apr. 2015.