Hunt for Predisposing Factors in Recurrent Yeast Infections

OB/GYN News, Oct 1, 2000 by Sherry Boschert

BIG SKY, MONT. -- Look beyond a recurrent vaginal yeast infection for treatable factors that can predispose women to repeated yeast infections, Dr. Lane J. Mercer said at an ob.gyn. update sponsored by the University of Chicago.

Recognizing and treating previously undiagnosed sugar intolerance, immunosuppression, or hypothyroidism will help stave off recurrent yeast infections. Changing certain eating habits, antibiotic therapies, or environmental factors also can lower the risk for future yeast infections, said Dr. Mercer, professor of ob.gyn. at Northwestern University, Chicago.

* Sugar Intolerance. Almost every month Dr. Mercer diagnoses frank type 2 diabetes that has gone unrecognized in a patient referred to him for severe recurrent yeast infections. Such women tend to be older, he said.

"You would think that most [physicians] would know to draw a blood glucose level and see what's going on," but too often that's not the case, he said.

Another form of sugar intolerance--hypoglycemia--also can predispose a woman to yeast infection. The condition typically occurs in young, athletic women who report that they get tired or sleepy after eating a meal of pasta. In these patients, blood sugar increases after the consumption of a large load of carbohydrates, which leaves glucose deposits in the vaginal fluids, saliva, sweat, and tissues until the pancreas produces an insulin response 30 minutes later.

Most clinicians no longer obtain 30-minute glucose values, but shorter glucose tests may not always indicate a problem when one is present, he cautioned.

* Dietary Excess. Dr. Mercer said he can reliably predict that his referral gynecologic practice will be busy with yeast infections around Christmas, Valentine's Day, and Easter, because that's when many women binge on sweets.

He said that he would rather see a woman eat an entire box of cookies one at a time throughout the day than eat all the cookies at one sitting. Even women with normal insulin production may not be able to handle a large volume of sugar that's ingested quickly, predisposing them to vaginal yeast infection.

* Antibiotic Therapy. Some antibiotics kill more lactobacilli than others do, which can contribute to yeast infections. Clarithromycin (Biaxin) is particularly problematic. "There is nothing more lethal to lactobacilli than Biaxin," he said. Because it's much less harmful to lactobacilli, physicians should prescribe azithromycin instead of clarithromycin, Dr. Mercer suggested.

* Immunosuppression. Whether it's caused by steroid use or HIV infection, a suppressed immune system can contribute to recurrent yeast infections. "You're obligated to test for HIV" in any woman with recurrent yeast infection, Dr. Mercer said.

* Hypothyroidism. Many women in their 40s have hypothyroidism but don't know it, so check thyroid-stimulating hormone (TSH) levels in those who experience recurrent yeast infections.

If a lab report comes back with, say, two mildly abnormal values, "I find nothing wrong with giving about a 0.25-mg dosing of Synthroid (levothyroxine sodium) to boost up the patient, then repeat the TSH and thyroid function tests in 3-6 weeks and see where they are," Dr. Mercer said.

* Environmental Factors. Spermicides can also be highly lethal to lactobacilli in some patients, contributing to their yeast infections.

Non-candida fungal infections also may sometimes be mistaken for recurrent yeast infections. Such fungal infections may be transmitted to patients from inanimate objects or even from an infected partner.

"These are the tinea cruris species. It's jock itch" rather than a true fungal vulvovaginitis, Dr. Mercer explained. Ask about the prescence of jock itch or athlete's foot in the patient's partner.