What is the best work-up and management for chronic yeast infections?
If a woman suspects she is having recurrent vaginal yeast infections, the first step is to keep a record or diary of of the events for the 48 hours preceding the occurrence of vaginal discharge or vulvar irritation.
During the 3rd or 4th episode within a year, go to the physician and ask to have a microscopic exam for yeast or vaginal culture for yeast. The diagnosis needs to be confirmed before embarking on a long term treatment.
If you do not have confidence in your gynecologist to be receptive to these requests, try a dermatologist. They often treat vulvar dermatoses including yeast vulvitis.
Once it has been confirmed that the problem is primary yeast infection recurrence, then a treatment program can be begun. Basically you must determine the regularity with which infections occur or the preceding events that predispose to an infection.
Then start a prophylactic regimen of one dose on just a slightly less frequency than the occurrences or to immediately follow an event that seems to predispose to the infection.
In other words, if the infections seem to occur monthly after the menses, then using an anti-yeast treatment just before or during the menses would be the best strategy.
If the yeast episodes always seem to occur after a week of carbohydrate binging, a course of antibiotics or a burst of steroids for another medical problem, then use the anti-yeast treatment right at the end of the inciting episode before it gets going.
Candidates to use for prophylactic treatment for yeast vaginitis prevention include:
- terconazole (Terazole ®) vaginal cream (15) or suppository one application each week.
- fluconazole (Diflucan ®) 150 mg orally each week or month.
- boric acid vaginal suppositories (16), one each week or month
- tea tree oil vaginal suppositories (concentrations of 0.5% to 2%) (17 ) used once a week or month