Yeast Vaginitis - Treat the Symptoms or Diagnose by Culture?

By Frederick R. Jelovsek, M.D.,

With symptoms of vaginal burning and a white, curdy discharge, many women have learned to self-treat with non-prescription, over-the-counter anti fungal medications. They are wrong only 25% of the time.(1) In many instances though, this treatment may permanently cure the problem. But what happens when the symptoms quickly recur or when this is the fourth time in a year to get an infection?

The answer for an accurate diagnosis to make sure the infection is due to yeast organisms (Candida albicans). For the first step, doctors usually look under the microscope at a wet prep of the discharge to identify yeast organisms. It is important for the doctor to make sure there is not a trichomonal or bacterial infection. Sometimes however, a woman can have a yeast infection but the number of organisms is too low to show up under the microscopic exam. On other occasions, the microscopic wet prep may show yeast organisms but they may be resistant to the common medications. They may also be yeast organisms other than the common Candida albicans yeast, such as non-albicans Candida species, Torulopsis glabrata or Saccharomyces cerevisiae which don't respond as well to the usual anti fungal medications.

At this point it is best to obtain a specimen of the vaginal discharge and send it for yeast culture. If it returns as Candida albicans or one of the other yeasts, this may represent a problem of resistant organisms and different therapies should be tried. If no yeast is cultured, that also is important in that it tells us to look for other uncommon causes of vaginitis such as physiologic discharge, allergic vaginitis, desquamative vaginitis, atrophic vaginitis or sometimes a vulvar irritation that is primary rather than being caused by a vaginal discharge.

In summary, any recurrent vaginitis (four or more in a year) should be cultured if it is thought to be a yeast vaginitis or if it is not clear from the microscopic wet prep what the organism is.

1. Ferris DG, Dedle C, Litaker MS. Women's use of over-the- counter anti fungal pharmaceutical products for gynecologic symptoms. J Fam Pract 1996;42:595-600.