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This article originally appeared in the April 1996
under the title "On the Teen Scene: An Itch Like No Other."
This version contains revisions made in March 1997.
by Judith Levine Willis
It's an itchy feeling you might hardly notice at first.
Maybe, you muse, it's just that your jeans are too tight.
Actually, tight jeans may have something to do with it. But if the itch keeps getting itchier, even when your jeans have been off for awhile, then there's something else involved.
That something else could very well be a fungus whose technical name is Candida, and which causes what is often called a "yeast" infection. Such infections are most common in teenage girls and women aged 16 to 35, although they can occur in girls as young as 10 or 11 and in older women (and less often, in men and boys as well). You do not have to be sexually active to get a yeast infection.
The Food and Drug Administration now allows medicines that used to be prescription-only to be sold without a prescription to treat vaginal yeast infections that keep coming back. But before you run out and buy one, if you've never been treated for a yeast infection you should see a doctor. Your doctor may advise you to use one of the over-the-counter products or may prescribe a drug called Diflucan (fluconazole). FDA recently approved the drug, a tablet taken by mouth, for clearing up yeast infections with just one dose.
Though itchiness is a main symptom of yeast infections, if you've never had one before, it's hard to be sure just what's causing your discomfort. After a doctor makes a diagnosis of vaginal yeast infection, if you should have one again, you can more easily recognize the symptoms that make it different from similar problems. If you have any doubts, though, you should contact your doctor.
In addition to intense itching, another symptom of a vaginal yeast infection is a white curdy or thick discharge that is mostly odorless. Although some women have discharges midway between their menstrual periods, these are usually not yeast infections, especially if there's no itching.
Other symptoms of a vaginal yeast infection include:
It's important to remember that not all girls and women experience all these symptoms, and if intense itching is not present it's probably something else.
Candida is a fungus often present in the human body. It only causes problems when there's too much of it. Then infections can occur not only in the vagina but in other parts of the body as well--and in both sexes. Though there are four different types of Candida that can cause these infections, nearly 80 percent are caused by a variety called Candida albicans.
The biggest cause of Candida infections is lowered immunity. This can happen when you get run down from doing too much and not getting enough rest. Or it can happen as a result of illness.
Though not usual, repeated yeast infections, especially if they don't clear up with proper treatment, may sometimes be the first sign that a woman is infected with HIV, the virus that causes AIDS.
FDA requires that over-the-counter (OTC) products to treat yeast infections carry the following warning:
"If you experience vaginal yeast infections frequently (they recur within a two-month period) or if you have vaginal yeast infections that do not clear up easily with proper treatment, you should see your doctor promptly to determine the cause and receive proper medical care."
Repeated yeast infections can also be caused by other, less serious, illnesses or physical and mental stress. Other causes include:
Some women get mild yeast infections towards the end of their menstrual periods, possibly in response to the body's hormonal changes. These mild infections sometimes go away without treatment as the menstrual cycle progresses. Pregnant women are also more prone to develop yeast infections.
Sometimes hot, humid weather can make it easier for yeast infections to develop. And wearing layers of clothing in the winter that make you too warm indoors can also increase the likelihood of infection.
"Candida infections are not usually thought of as sexually transmitted diseases," says Renata Albrecht, M.D., of FDA's division of anti-infective drug products. But, she adds, they can be transmitted during sex.
The best way not to have to worry about getting yeast infections this way is not to have sex. But if you do have sex, using a condom will help prevent transmission of yeast infections, just as it helps prevent transmission of more commonly sexually transmitted diseases, including HIV infection, and helps prevent pregnancy. Teens should always use a latex condom if they have sex, even if they are also using other forms of birth control. (See "On the Teen Scene: Preventing STDs" in the June 1993 FDA Consumer.)
If one partner has a yeast infection, the other partner should also be treated for it. A man is less likely than a woman to be aware of having a yeast infection because he may not have any symptoms. When symptoms do occur, they may include a moist, white, scaling rash on the penis, and itchiness or redness under the foreskin. As with females, lowered immunity, rather than sexual transmission, is the most frequent cause of genital yeast infections in males.
The OTC products for vaginal yeast infections have one of four active ingredients: butoconazole nitrate (Femstat 3), clotrimazole (Gyne-Lotrimin and others), miconazole (Monistat 7 and others), and tioconazole (Vagistat). These drugs are in the same anti-fungal family and work in similar ways to break down the cell wall of the Candida organism until it dissolves. FDA approved the switch of Femstat 3 from prescription to OTC status December 1996 and a similar switch for Vagistat in February 1997. The others have been available OTC for a few years.
When you visit the doctor the first time you have a yeast infection, you can ask which product may be best for you and discuss the advantages of the different forms the products come in: vaginal suppositories (inserts) and creams with special applicators. Remember to read the warnings on the product's labeling carefully and follow the directions.
Symptoms usually improve within a few days, but it's important to continue using the medication for the number of days directed, even if you no longer have symptoms.
Contact your doctor if you have the following:
OTC products are only for vaginal yeast infections. They should not be used by men or for yeast infections in other areas of the body, such as the mouth or under the fingernails.
Candida infections in the mouth are often called "thrush." Symptoms include creamy white patches that cover painful areas in the mouth, throat, or on the tongue. Because other infections cause similar symptoms, it's important to go to a doctor for an accurate diagnosis.
Wearing artificial fingernails increases the chance of getting yeast infections under the natural fingernails. Fungal infections start in the space between the artificial and natural nails, which become discolored. Treatment for these types of infections--as well as those that occur in other skin folds, such as underarms or between toes--require different products, most of which are available only with a doctor's prescription.
Knowing the causes and symptoms of yeast infections can help you take steps--such as giving those tight jeans a rest--to greatly reduce the chances of getting an infection.
And, if sometimes prevention isn't enough, help is easily at hand from your doctor and pharmacy.
Judith Levine Willis is editor of FDA Consumer.
Here are some steps young women can take to make vaginal yeast infections less likely:
Publication No. (FDA) 97-2301
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