Are resistant yeast strains a common cause of recurrent yeast infections?

In the long run, drug resistance of candida yeast strains presents a problem in that drugs are only effective for periods of years rather than for decades or forever.

For an individual woman, however, it does not appear that resistance to drugs is the main reason for chronic recurrences (6). The same strain of candida is often the etiology of the recurrent infection although sometimes the there is a change in the subspecies of candida from one infection to another (7).

This is not to say that drug resistance cannot play a role in recurrent yeast infections. In fact up to 10% of recurrent yeast infections can be due to a different yeast strain called torulopsis glabrata (now renamed candida glabrata) (8). This yeast strain is commonly resistant to many of the standard topical treatments as well as to oral fluconazole (DIflucan ®) (9, 10).

What are the best treatments for recurrent candida yeast infection?

Butoconazole may be more effective than other anti-yeast treatments against non-candida albicans which are more often resistant to fluconazole (DIflucan ®) and terconazole (Terazole ®) (11).

Since this topical treatment is available without prescription, it is a good agent to use for chronic recurrences. Boric acid vaginal suppositories can also be effective against both candida albicans and candida glabrata (12).

Can these episodes of infections be prevented?

Weekly treatment with a terconazole vaginal cream (Terazol®) decreases episodes of yeast vaginitis (13). Yogurt with lactobacillus acidophillus cultures does not seem to decrease episodes of yeast vaginitis although it may somewhat reduce episodes of bacterial vaginitis (14).

Although in practice, many physicians have been prescribing weekly fluconazol (Diflucan ®) 150 mg by mouth, there have not as yet been studies showing whether this is an effective approach. It would seem that some sort of periodic treatment either weekly or monthly with either intravaginally or oral medication would be the best approach to prevent recurrences.

There are also several living habits and bodily care changes that are felt to help prevent vulvar skin irritation so that a secondary yeast vulvitis (as opposed to a primary yeast vaginitis) does not develop.

• Avoid pantyhose and tight pants such as jeans which trap moisture near the perineum
• After exercise or any sweat producing activity, bathing or swimming, make sure the perineum is air dryed. Moist surfaces that rub against each other break down and provide an area for yeast secondary growth
• Wear loose, all cotton underwear (not cotton crotch panties) that absorbs body moisture.
• Wipe front to back when you urinate or have a bowel movement. Bowel bacteria and yeast can cause vulvar skin breakdown and vaginal infection.
• Use tampons instead of sanitary pads. The chemicals in many pads can cause perineal skin irritation. Natural cotton pads that you launder in hypo allergenic detergent are alright to use.
• Do not shave the vulvar area. The pubic hair protects against chemicals making contact with the skin.
• Avoid all chemicals in the Vulvovaginal area.
• Follow a low carbohydrate diet with almost no simple carbohydrates, only a small amount of complex carbohydrates.
• Take steroids, antibiotics and oral contraceptives only if absolutely necessary.

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