In this recurring guest column, Kate White, M.D., of Boston Medical Center, answers your questions on all things gynecology. As the author of the Mayo Clinic Press book Your Sexual Health, she’s ready to dole out wisdom on sex, periods, menopause and more. Submit a question here.
Q: I keep getting terrible yeast infections. Last time, my doctor prescribed two doses of fluconazole, but I got another yeast infection a month later. Why does this keep happening? Are there options beyond getting antifungal medication every time an infection crops up?
A: Yeast infections can be truly beastly, especially when they come back again and again. Yeast is typically a permanent resident of the vagina, where it coexists peacefully with bacteria species. And the bacteria lactobacillus acts to prevent yeast overgrowth.
But certain conditions can lead to yeast running wild. These include recent antibiotic use, some forms of birth control, pregnancy, uncontrolled diabetes, as well as a weakened immune system due to chemotherapy, HIV or certain medications.
When yeast flares up, the automatic response is treatment with antifungals, whether an over-the-counter cream, ointment or suppository like miconazole (Monistat 3) or a prescription for the oral medication fluconazole (Diflucan). Since these antifungals don’t fully eradicate the yeast, it’s not uncommon to get repeat infections, even in a short period of time.
When I treat patients with recurrent yeast infections, I first offer a choice of two treatment plans.
The first is to treat any infections aggressively, with a longer than standard course of therapy. This could be three doses of oral fluconazole or an intravaginal cream for 10 nights. This approach is good for people who want to take medication only when they have an infection. But it doesn’t help prevent future infections — for that, you’ll want to try the second approach.
The second approach is to try suppressive therapy. You can take weekly fluconazole or use twice-weekly intravaginal cream for six months. This approach leads to long-term suppression of yeast infections for about half of people. If infections come back after this time, we can repeat the weekly or biweekly treatment for an entire year. That works for most people.
There are other remedies that we can try if antibiotics fail, such as boric acid, which is a tablet inserted into the vagina. An important note: Boric acid is fatal if swallowed, so it must be kept out of the reach of children and pets.
Probiotics and yogurt don’t seem to be effective — so please don’t put Chobani in your yoni. You may want to consider changing your birth control if you think it may be related to your infections or asking your health care team for a preventive dose of fluconazole when you take antibiotics.
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