YEAST INFECTIONS & Boric acid abstracts

[Guest guest]

I also added some thoughts at the end. By the way some other countries may use the term 'thrush' for vaginal yeast infections rather than yeast infections, where in the USA, thrush is generally meant to be the oral form.Dee

======================================

Yeast Infections

Gabe Mirkin, M.D.

When a woman develops a white discharge and vaginal itching, her doctor often diagnoses yeast infection, even though he may be wrong because every healthy woman has yeast in her vagina and cultures of the vagina almost always grow yeast, even in women who have no symptoms at all.

A doctor diagnoses yeast by inserting a cotton swab into the vagina, placing it in a drop of water and examining the fluid for yeast under a microscope. Cultures should not be used to diagnose yeast as most healthy women harbor yeast in their vaginas, mouths and intestines.

Yeast infections often follow taking antibiotics or birth control pills, but when yeast cause a rash on the genitals, it often is acquired through heterosexual contact or it can be caused by immune defects associated with diseases such as diabetes or HIV. When normal healthy people develop rashes caused by yeast, doctors should look for a cause.

Genital infections caused by yeast are often associated with a special type of yeast that is able to break though the skin to cause a red, itchy rash. Men and women with genital rashes caused by yeast either have an immune defect such as diabetes or they have a special type of yeast that can be acquired through sexual contact.

Women who have documented yeast infections and a rash from it can be cured when they and their partners take ketoconazole, 400mg daily for 14 days, or fluconazole,150 mg/day for four days.

Women who keep on getting documented yeast infections may need to take itraconazole 50 to 100mg daily or fluconazole 100mg weekly or 150mg monthly. Short courses of topical therapy, e.g. 500mg clotrimazole pessaries as a single weekly dose for six months or 100mg miconazole pessaries twice weekly for 3 months, followed by once weekly for 3 months may also be used.

Since yeast is a normal inhabitant in the vagina, it is often diagnosed as the cause of vaginal itching when it is only an innocent bystander.

When a physician takes cultures for many different types of infections and finds only a yeast, he usually prescribes suppositories (over-the-counter clotrimazole vaginal suppository, once a day for three days) to kill yeast and the patient feels better for a week or so because the suppository lubricates the irritated area.

Then the itching returns because these women often are infected with mycoplasma which is extraordinarily difficult to find on culture and can be cured when they and their partners take azithromycin (250 mg once a day for 9 days) to kill the mycoplasma. If a woman really has a vaginal yeast infection, she usually clears up with a pill called fluconazole (150 mg/day for 4 days). (Diflucan, dee t)

A study from the University of Leeds showed that women who get yeast infections over and over, have the same type of yeast that recurs; it is not a new infection. This means that women with recurrent yeast infections and their partners should be treated for several weeks with oral drugs to kill yeast such a Diflucan, and not just with vaginal suppositories (4).

1) J Warszawski, L Meyer, N Bajos. Is genital mycosis associated with HIV risk behaviors among heterosexuals? American Journal of Public Health 86: 8 Part 1(AUG 1996):1108-1111.

2) One paper recommends a vaginal suppository containing metronidazole and miconazole, twice a day for two weeks, to kill gardnerella, Trichomonas and yeast. S Kukner, T Ergin, N Cicek, M Ugur, H Yesilyurt, O Gokmen. Treatment of vaginitis. International Journal of Gynecology & Obstetrics 52: 1(JAN 1996):43-47. Metronidazole 500 mg and miconazole nitrate 100 mg (Neo-Penotran®, Embil Pharmacy Company, Istanbul, Turkey) insert twice daily for 14 days.

3) NC Nwokolo, FC Boag. Chronic vaginal candidiasis - Management in the postmenopausal patient. Drugs & Aging, 2000, Vol 16, Iss 5, pp 335-339.

4) An investigation into the pathogenesis of vulvo-vaginal candidosis. Sexually Transmitted Infections, 2001, Vol 77, Iss 3, pp 179-183. SS ElDin, MT Reynolds, HR Ashbee, RC Barton, EGV .3/9/08

=================================

A few thoughts; (and some abstracts on using Boric acid)

I also know there are several varieties of yeast where the typical candida medications will not eradicate them... and more and more strains are becoming resistant to the 'azole' types of medications. One is T-glabrata. (or candida glabrata) One anti-yeast medication that works for that strain (and candida) is called Vagistat 1, (An OTC, one time tablet inserted)... with tioconizole in it. It can burn or irritate (no doubt about that) *ouch* but worth it for one day and by the next day or so I'd be fine and it was gone.

Another that's even recommended by physicians and works as well (so their studies show *see below*) is the use of Boric acid. Made up in prepackaged capsules that are inserted, or one can make them up themselves. (I used to) I can also agree that yeast infections may be passed back and forth to the partner and why both should be treated if it's chronic, but most physicians 'pooh pooh' that idea. But the above article mentioning mycoplasma, also makes the case that at times 'antibiotics' can be very effective.

Another thing I've learned is that far too often the actual yeast infection IS cleared up but we are left with the searing inflammation of one... (and we assume it's the yeast still there) and too often we'll use the meds again sometimes even causing a chemical burn at that stage, but it's more likely an overactive immune system stuck in 'overdrive' and the body is overproducing 'histamine' (and other cytokines) giving us those symptoms and it doesn't know when to quit... and that is the time to try an anti-histamine to quell that down. It's certainly always helped me get over that hump.

One last one; I've oftened wondered if our state of stress or emotional nature at the time does have something to do with weakening our immune systems that allows yeast/thrush to get out of control. (Normally yeast should be there but our healthy immune systems keep it in check or balance most of the time). I remember many years ago a physician asking me the state of my marriage at the time. Of course I thought he was being a bit silly, and said it's fine, but only in hindsite (after I got out of it) did I really realize that a lot was going on that I kept buried at the time. So maybe? Once I was out of that relationship I rarely had yeast infections by the way.

Here are a few abstracts on using the Boric acid and it's benefits.

Abstracts on Boric Acid & candida (yeast infections)1. Efficacy of maintenance therapy with topical boric acid in comparison with oral itraconazole in the treatment of recurrent vulvovaginal candidiasisMarch 2001 . Volume 184 . Number 4 Abstract Objective: Our purpose was to examine the efficacy of a topical long-term treatment with boric acid versus an oral long-term treatment (itraconazole) in the cure and prevention of recurrent vulvovaginal candidiasis.Study Design: A prospective, nonrandomized study of patients affected by recurrent vulvovaginal candidiasis was undertaken. In 3 years we recruited 22 consecutive patients who underwent therapy with itraconazole (group 1) or boric acid (group 2). Women were followed up for 1 year, with clinic and microbiologic controls after 1, 3, 6, and 12 months after the first visit.Results: During the treatment, the positive culture results (15.1% vs 12.1%) and the signs and symptoms (33.3% vs 24.2%) were similar within the 2 groups, with no significant statistical difference. With the withdrawal, after 6 months, 'relapses' were common in both of the 2 groups (54.5%).Conclusions: Boric acid seems to be a valid and promising therapy both in the cure of the vaginal infection and in the prevention of relapses of recurrent vulvovaginal candidiasis, but its efficacy ends with the suspension of the therapy. (Am J Obstet Gynecol 2001;184:598-602.) =========================================2. Treatment of vaginitis caused by Candida glabrata: Use of topical boric acid and flucytosineNovember 2003 . Volume 189 . Number 5 Jack D. Sobel, MD., Walter Chaim, MD., Viji Nagappan, MD., Deborah Leaman, RN, BSN Abstract Objective The purpose of this study was to review the treatment outcome and safety of topical therapy with boric acid and flucytosine in women with Candida glabrata vaginitis.Study design This was a retrospective review of case records of 141 women with positive vaginal cultures of C glabrata at two sites, Wayne State University School of Medicine and Ben Gurion University.Results The boric acid regimen, 600 mg daily for 2 to 3 weeks, achieved clinical and mycologic success in 47 of 73 symptomatic women (64%) in Detroit and 27 of 38 symptomatic women (71%) in Beer Sheba. No advantage was observed in extending therapy for 14 to 21 days. Topical flucytosine cream administered nightly for 14 days was associated with a successful outcome in 27 of 30 of women (90%) whose condition had failed to respond to boric acid and azole therapy. Local side effects were uncommon with both regimens.Conclusions Topical boric acid and flucytosine are useful additions to therapy for women with azole-refractory C glabrata vaginitis.==============================================================3. Chronic fungal vaginitis: The value of cultures Abstract OBJECTIVE: Our purpose was to examine the importance of fungal cultures in evaluating patients with symptoms of chronic vaginitis by assessing the relative contribution of various yeast species and by comparing infections caused by Candida albicans with those caused by other species.STUDY DESIGN: A prospective observational study of patients referred with chronic vaginal symptoms was undertaken. In addition to a standard evaluation of symptoms, cultures for yeast were performed on modified Sabouraud agar plates.RESULTS: Seventy-seven isolates were obtained from 74 patients. A total of 68% were Candida albicans; 32% were other species. The clinical syndromes caused by non-Candida albicans isolates were indistinguishable from Candida albicans infections. Fluconazole gave a short-term mycologic cure in all Candida albicans but only 25% of non-Candida albicans cases. .

(NOTE* Fluconazole is Diflucan given orally, Dee)