Yeast Infections
Yeast infections are among the most common medical annoyances. If you have ever suffered through the redness and raised spots, itching and inflammation of "jock itch," vaginal infections, or penile inflammations, you know how irritating these infections can be.
Luckily, most yeast infections can be eliminated or controlled by good hygiene and over-the-counter topical antifungal medications. But how do you know you are really dealing with a yeast problem? And when should you get a urologist's opinion and advice? The following information should help answer these questions.
What causes yeast infections?
The term "yeast" is often used to describe infections caused by fungi which are microorganisms that appear most frequently in nature as molds, mildews, mushrooms and yeast. They are more complex than viruses or bacteria.
Although there are over 100,000 different species of fungi, only 200 of them are able to cause disease. In most healthy individuals, yeast infections do not present a significant health problem although they affect millions of individuals. In fact, an epidemiology study of a large urban and suburban area indicated that 178.3 per million people experienced yeast infections that caused infections that affected the whole body.
What are the symptoms of yeast infections?
For most individuals, the symptoms of yeast infections are skin redness and itchiness. The most common infections are jock itch, vaginal infections and penile inflammation.
With "jock itch," a reddened rash spreads from the penis outward over the inner thighs, anal area and buttocks. In addition to itching, you may notice a burning sensation in the groin.
Vaginal yeast infections are among the most bothersome nuisance in women, particularly ages 20 to 40. The infection produces intense itching or burning that can lead to discomfort when urinating, and can cause discomfort with sexual intercourse. Vaginal yeast may also produce a thick, white discharge that looks like cottage cheese. While some women may have no symptoms, others suffer from redness and swelling of the vagina or labia, as well as the tissues surrounding the vaginal opening. Vaginal infections may also be painless and long lasting. They are often associated with the use of antibiotics or birth control medications. Some people have vulnerable immune systems which make them more susceptible to the infection.
In males an infection that causes swelling and redness of the head of the penis is called balanitis. It is hard to control and frequently recurs in uncircumcised males.
While yeast infections are relatively harmless, they may invade the body by causing infection of the adrenal, kidney, ureter, bladder, prostate and female genital organs.
Increased vulnerability to these invasive yeast infections develop in diabetics, individuals who use steroids such as cortisone, in organ transplant recipients, in individuals with a disease like AIDS or with other immune compromised conditions. You may also be at risk if other major diseases weaken your health such as cancer, liver disease, chronic inflammatory bowel syndrome or rheumatoid arthritis.
Many of these same chronically ill patients are at risk of secondary or opportunistic infections. These are infections that take hold when a body's immune system is reduced because of major illness, a transplant or drugs like chemotherapy. Infections can also involve every part of the human body, including the urinary tract.
Nasty and difficult to treat, opportunistic infections can be caused by environmental fungi—e.g., aspergilla and cryptococcus—they can become harmful when you are in poor health.
A second group of fungi are linked to the environment and can be found in soil, animals or trees. These include the blastomyces, coccidiodes and histoplasma species, all of which can cause infection in exposed individuals. People who live in the mid-west may develop infections caused by blastomyces, a fungus that can be found on the shoreline of lakes, rivers and ponds. Coccidiodes is found in the hot, dry climate of deserts. Histoplasma can be found in construction sites, bird sanctuaries or caves where there are large bat populations. In most individuals, exposure to these fungi will result in a minor respiratory or "flu-like" syndrome that is self-limited and may cause minor changes that can be seen on a chest X-ray.
Also, in certain clinical settings, fungi can become invasive. Long-term stays in hospitals increase the patient's vulnerability to the opportunistic infections frequently caused by the Candida species of fungi. Fungi cause over 7 percent of hospital-acquired infections. The fungus may gather in the urinary tract in patients who have catheters for a long time.
Standard laboratory tests may not detect either an invasive or opportunistic fungus. Urine that repeatedly demonstrates red or white blood cells (sign of inflammation) will alert your urologist to an underlying problem. Other physical findings such as persistent fever, rash or other laboratory signs (such as abnormal blood counts). You may require imaging studies, such as ultrasonography or a CT scan, to evaluate possible effects on your kidney or bladder.
How are yeast infections treated?
Skin and groin infections can be eliminated or controlled by good hygiene. Frequent bathing and the routine changing of undergarments especially during hot weather or after intense physical activity are advised.
In most individuals, control of superficial infection like jock itch, can be achieved by the use of topical antifungal creams that are readily available as over-the-counter medications. They can be found under different names such as butoconazole, clotrimazole, miconazole and terconazole. Persistent fungal infections require stronger medication such as nystatin or oral medications such as fluconazole or Lamisil.
Most vaginal infections can be treated with vaginal suppositories or creams. In cases of persistent infection, the use of oral medications such as fluconazole or ketoconazole will be helpful. Chronic and recurring vaginal infections may require a change in birth control methods.
If an infection involving the head of the penis on an uncircumcised male does not respond to topical creams, then circumcision may be the cure.
In cases of urinary fungal infections, removing or changing a catheter will eliminate the infection in one-third of patients. The use of bladder irrigations with antifungal medication (amphotericin B) or system medication (oral or intravenous fluconazole, or intravenous amphotericin B) will be effective in control of infection in 60 percent of patients. However, the patient's underlying illness or poor immune status may cause repeat infection that requires treatment. Invasive yeast infections require systemic antifungal therapy with the use of amphotericin B, fluconazole, itraconazole and caspofungin and newer drugs related to fluconazole (posaconazole).
What can I expect after treatment for yeast infections?
While most superficial skin or vaginal infections respond to topical creams and ointments, they often return. Vaginal infections, in particular, can be difficult to eliminate in some patients, especially if they are caused by a resistant strain of yeast.
Controlling invasive or chronic systemic infections may take a long-term (weeks to months) prescribed program of systemic antifungal drugs. If you are one of these patients, you will be closely monitored for any underlying contributing factor. Your doctor will be interested in improving your nutritional support, stabilizing any diabetic conditions and eliminating catheters that might be causing the problem.
With improved overall health and effective antifungal therapy, chronic systemic infections can be destroyed. But in certain cases, a persistent fungal disease indicates a severe underlying problem that must also be treated if there is to be a cure.
Frequently asked questions:
What puts me at higher risk for vaginal yeast infections?
Vaginal yeast infections are often the result of certain medications, such as steroids and antibiotics taken for other dental, respiratory or even bacterial urinary infections. Birth control pills and devices can put you at risk for increased incidence, as can the hormonal changes associated with menstruation, pregnancy and diabetes.
Could a yeast infection be the source of my fatigue and depression?
No. While books and articles blame fatigue and depression on hidden yeast infections, these observations are often based on hearsay rather than true scientific observation. It is unusual for yeast infections to cause chronic fatigue or depression.
Can yeast infections be transmitted to another family member?
Superficial infections are generally not contagious. If you have good hygiene and routinely launder your clothes, it is also unlikely that you will transmit an invasive infection to someone else.
Can a change in diet or herbal remedies prevent or cure a yeast infection?
Scientists do not know why fungal infections develop in some individuals and not others. They also are not sure just how diet might impact the problem or herbal remedies help it. But they do know that diabetic patients have an increased vulnerability to these infections, leading them to suggest that anyone diagnosed with diabetes should avoid high carbohydrate diets. Yogurt may provide normal microorganisms for the genitourinary tract, so many advocate it as a preventative measure or treatment of yeast infections.
Can infants and children get fungal infections?
Yes. Common diaper rash in infants and toddlers is typically a low grade, superficial fungal infection, caused by the same fungi—Candida albicans—that trigger other moist area yeast infections. Marked by an itchy red rash with flaky white patches, the rash can usually be controlled by frequent changing and, if necessary, medicated powders.
Reviewed January 2011
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