Unnecessary or inappropriate use of topical preparations is common and can lead to a delay in the treatment of other causes of vulvovaginitis, which can result in worse outcomes.When there are more than four recurrent episodes of candidal vulvovaginitis per year, a longer initial treatment course is recommended, such as orally administered fluconazole followed by a second and third dose 3 and 6 days later, respectively.Other treatments after more than four episodes per year, may include ten days of either oral or topical treatment followed by fluconazole orally once per week for six months. About 10-15% of recurrent candidal vulvovaginitis cases are due to non-Candida albicans species. Non-albicans species tend to have higher levels of resistance to fluconazole. Therefore, recurrence or persistence of symptoms while on treatment indicates speciation and antifungal resistance tests to tailor antifungal treatment. Alternative medicine
Up to 40% of women seek alternatives to treat vaginal yeast infection. Example products are herbal preparations, probiotics and vaginal acidifying agents. Other alternative treatment approaches include switching contraceptive, treatment of the sexual partner and gentian violet. However, the effectiveness of such treatments has not received much study.Probiotics (either as pills or as yogurt) do not appear to decrease the rate of occurrence of vaginal yeast infections. No benefit has been found for active infections. Example probiotics purported to treat and prevent candida infections are Lactobacillus fermentum RC-14, Lactobacillus fermentum B-54, Lactobacillus rhamnosus GR-1, Lactobacillus rhamnosus GG and Lactobacillus acidophilus.There is no evidence to support the use of special cleansing diets and colonic hydrotherapy for prevention.
Broad-spectrum antibiotics kill healthy bacteria in the vagina, such as Lactobacillus. These bacteria normally help to limit yeast colonization.Oral contraceptive use is also associated with increased risk of vaginal thrush. Pregnancy
In pregnancy, higher levels of estrogen make a woman more likely to develop a yeast infection. During pregnancy, the Candida fungus is more common, and recurrent infection is also more likely. There is tentative evidence that treatment of asymptomatic candidal vulvovaginitis in pregnancy reduces the risk of preterm birth. Lifestyle
While infections may occur without sex, a high frequency of intercourse increases the risk. Personal hygiene methods or tight-fitting clothing, such as tights and thong underwear, do not appear to increase the risk. Diseases
Those with poorly controlled diabetes have increased rates of infection while those with well controlled diabetes do not. The risk of developing thrush is also increased when there is poor immune function, as with HIV/AIDS, or in those receiving chemotherapy. Diet
A diet high in sugar may increase the risk of vaginal thrush; in some women, reducing sugar intake seems to reduce the risk of reoccurring vaginal thrush. Species of yeast responsible
While Candida albicans is the most common yeast species associated with vaginal thrush, infection by other types of yeast can produce similar symptoms. A Hungarian study of 370 patients with confirmed vaginal yeast infections identified the following types of infection:
Candida albicans: 85.7%
Non-albicans Candida (8 species): 13.2%
Saccharomyces cerevisiae: 0.8%
Candida albicans and Candida glabrata: 0.3%Non-albicans Candida are often found in complicated cases of vaginal thrush in which the first line of treatment is ineffective.