What are the best treatments for yeast infections?

Vaginal yeast infections can be painful, uncomfortable and embarrassing to talk about. 75% of women have at least one yeast infection in their lifetime, so it is very common. Yeast infections can happen to anyone, however, there are risk factors that can increase your chances of getting this infection. There are various treatment options for yeast infections and they usually clear up quickly.

Key points on yeast infections:

• There is a healthy balance of bacteria and yeast in your vagina. When this balance is thrown off, it gives the fungus, candida, an opportunity to overgrow and leave you with a yeast infection.
• The main symptoms of a yeast infection are itching and discomfort. Other symptoms include pain with urination, painful sexual intercourse, redness of the vagina and thick, white discharge from the vagina. 
• There are many factors which can make you susceptible to yeast infections: pregnancy, diabetes, antibiotic use, oral contraceptives or hormones and an impaired immune system.
• You can adopt many practices to prevent a yeast infection. Avoid wearing tight or wet clothes. Do not use scented products on your vagina. Do not douche as it removes the healthy bacteria in your vagina. Avoid hot tubs and very hot baths. Avoiding these practices can keep help prevent yeast infections. 

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Treatments

There are many treatment options for yeast infections. They usually depend on the severity of your infection. 

Mild and moderate symptoms are treated with:

• Antifungals. This is a short course of antifungal medication, usually for a 3-7 days. They come in the form of creams, ointments, tablets or suppositories. Some require a doctor's prescription while others you can get over the counter. 
• Over-the-counter medications: 
  • Vaginal creams: These are applied to the inside of your vagina to help kill off the fungi. They might come with an applicator to help you measure the right dose and to enable easy application. These can be slightly messy and leak so its best to use them at bedtime. Common medications are:
    • Clotrimazole
    • Butaconazole
    • Miconazole nitrate
    • Tioconazole
  • Tablets or suppositories: Some of the aforementioned medications, such as clotrimazole and miconazole, can come in the form of tablets or suppositories. The suppositories are to be inserted into the vagina. These are sometimes preferred over creams as they are less messy. 
• Oral Medication: Your doctor may prescribe you a single one-off dose of fluconazole. This is not a recemmended option if you are pregnant.  

If your symptoms do not disappear or return within 2 months.  See your doctor to discuss options.  When taking antifungals, make sure to take the medication as recommended and finish the course. An incompleted course may not fully treat the infection and thus recurrence becomes more likely.

Severe or recurrent yeast infections require a stronger treatment plan.

• Antifungals: Your doctor may prescribe a longer course of oral or intravaginal antifungals, lasting up to 2 weeks.  This is then followed by treatment once weeekly for 6 months. 
• Azole resistant therapy: For yeast infections resistant to standard treatment options, your doctor may recommend boric acid.  Boric acid comes in capsule form that is inserted into the vagina.  This should NOT be taken orally as it can be fatal. 

When applying ointments or creams, it is important to note that these can weaken condoms or diaphragms.  This in turn may increase your chances of pregnancy or of contracting an STI.  It is important to read all the instructions and warnings before use. 

Individuals who are immunocompromised or have diabetes may be prone to frequent yeast infections. This condition is called recurrent vulvovaginal candidiases. Your doctor might prescribe you a weekly dose of oral fluconazole for 6 months if you yeast infections at least 4 times a year. 

Sources

• "What Are Vaginal Yeast Infections?". WebMD, 2020 [accessed 5 April 2020].
• "Yeast infection (vaginal) - Symptoms and causes", 2020 [accessed 5 April 2020].
• "Yeast infection (vaginal) - Diagnosis and treatment - Mayo Clinic", 2020 [accessed 5 April 2020]. 
• "Over-the-Counter Treatments for Yeast Infections", WebMD, 2020 [accessed 5 April 2020].

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