Yeast Infection (Vaginal Candidiasis)

A vaginal yeast infection (vulvovaginal candidiasis) is a fungal infection caused by an overgrowth of Candida yeast, which naturally lives in the vagina in small amounts. When the balance of bacteria and yeast in the vagina is disrupted, Candida can overgrow and cause symptoms. **Types of Candidiasis:** - **Uncomplicated VVC** — Sporadic, mild-to-moderate symptoms, likely Candida albicans, responds to short-course therapy - **Complicated VVC** — Recurrent (4+/year), severe symptoms, non-albicans species, or in immunocompromised/diabetic patients - **Recurrent VVC** — 4 or more episodes in 12 months, requires different management approach **The Vaginal Ecosystem:** The vagina contains a balanced mix of bacteria and yeast. Lactobacillus bacteria produce lactic acid that keeps the vagina slightly acidic (pH 3.8-4.5), which prevents yeast overgrowth. Anything that disrupts this balance — antibiotics, hormones, immune changes — can trigger a yeast infection. **Common Misconception:** Yeast infections are NOT sexually transmitted infections (STIs), though sexual activity can sometimes trigger them. They can occur in women who are not sexually active.

**Uncomplicated Yeast Infections:** - **OTC Topical Azoles** — Miconazole (Monistat) or clotrimazole (Gyne-Lotrimin) as creams or suppositories for 1-7 days - **Prescription Oral** — Fluconazole (Diflucan) single 150mg dose — equally effective, more convenient **Complicated/Recurrent Infections:** - Longer treatment course (7-14 days topical or multiple doses of fluconazole) - Maintenance therapy: fluconazole weekly for 6 months - Consider non-albicans species testing if treatment fails - Address underlying factors (diabetes control, immune status) **During Pregnancy:** - Topical azoles only (7-day course preferred) - Oral fluconazole is NOT recommended during pregnancy **Probiotics:** Lactobacillus supplements may help restore vaginal flora and prevent recurrence, though evidence is still emerging.