Yeast Infections

A yeast infection is a fungal infection on the skin or mucous membranes. Yeast infections are caused by the fungus Candida, and thus are also referred to as candidiasis. The most common yeast infection sites are the vagina and vulva (vulvovaginal candidiasis), the nails (onychomycosis), and the mouth and/or throat (oral thrush). Although vaginal yeast infections are more common than penile yeast infections, both males and females can have yeast infections of the genitals.

 

Yeast Infections in Females

Vaginal yeast infections are commonly referred to simply as “yeast infections.” Yeast infections are common; 75% of females will have a vaginal yeast infection at some point in their lives,2 and 40% of females will get more than one.6

 

Causes of Yeast Infections

Yeast infections are caused by a fungal overgrowth in the vagina and/or vulva. The fungus Candida albicans is usually present on the skin and mucus membranes of healthy individuals. Candida albicans is present in a healthy vagina, and in most cases is not a cause for concern because the levels of Candida albicans are kept under control by the “good” bacteria Lactobacillus. However, when an imbalance in the body reduces the amount of Lactobacillus or prevents them from functioning, the pH of the vagina can be altered, which leads to an overgrowth of fungus.2 The change in pH can have many causes, including the following:

  • Antibiotic use (which can kill the Lactobacillus bacteria as well as the harmful bacteria that the antibiotics are prescribed to treat)2
  • Fluctuations in hormones due to pregnancy, hormonal birth control, or hormone therapy8
  • Uncontrolled diabetes2
  • A weakened immune system, often as a result of HIV/AIDS
  • Stress2
  • Lack of sleep2
  • Hot, humid weather and/or non-ventilating clothing6
  • A bad diet, especially one high in carbohydrates such as refined sugars and alcohol6
  • Potential irritants to the vagina such as soaps, powders, deodorants, and other products6
  • Douching
  • Spermicidal lubricants

 

Candida albicans is the most common strain of Candida present in the vagina, and thus is usually the cause of yeast infections. Rarely, other strains cause yeast infections, and require different treatment. If a person has frequent, recurring yeast infections, his or her doctor may test for the presence of a different strain of Candida and prescribe a treatment targeted towards that strain.2

 

Symptoms and Diagnosis

Yeast infections generally cause mild to moderate discomfort, but symptoms can become more severe if the infection is present for an extended period of time. Yeast infections are categorized as either simple/uncomplicated or complicated. Uncomplicated yeast infections are not recurring or persistent and have mild to moderate symptoms.3 Common symptoms of an uncomplicated yeast infection include the following:

  • Itching2
  • Burning, especially during urination2
  • Changes in vaginal discharge; often thick, white, and odorless, with a cottage-cheese like appearance3
  • Pain during sex2
  • Rash3
  • Soreness of the vaginal area2

 

Complicated yeast infections may have more severe symptoms and could require a different course of treatment than uncomplicated yeast infections. A yeast infection is considered to be complicated if any of the following factors are present:

  • Severe redness, swelling, or itching so that leads to cracks, sores, or tears in the vaginal tissue3
  • Recurrent infections,2 generally 4 or more infections in a year3
  • Uncontrolled diabetes2
  • Pregnancy2
  • A weakened immune system due to medications or HIV/AIDS3
  • A strain of Candida other than Candida albicans3

           

If this is your first time experiencing symptoms of a yeast infection, it is important to see your doctor or healthcare provider for a diagnosis and treatment. Symptoms of a yeast infection may mimic the symptoms of bacterial vaginosis (BV), another vaginal infection, but these infections require vastly different treatments. Inflammation or infection of the vagina and/or vulva is referred to as vaginitis. One third of all cases of vaginitis are caused by yeast infections.4 Yeast infections are the second most common cause of vaginitis, the first being bacterial vaginosis (BV). Although yeast infections are uncomfortable and bothersome, they are not serious infections and do not have long-term consequences.

 

Certain sexually transmitted infections (STIs) such as chlamydia and gonorrhea may have yeast-infection-like symptoms, but they will not respond to the yeast infection treatment, and can have serious complications if left untreated, including infertility.7

 

When you see your doctor or healthcare provider, they will start by taking a detailed medical history, making sure to ask whether you have had a yeast infection in the past, if you have ever had an STI, or if you are pregnant.2 After taking a medical history, they will perform a pelvic exam.2 They will look at the vulva for signs and symptoms (such as redness and irritation), and will also examine the vaginal walls and cervix. Although a doctor can often diagnose a yeast infection with a simple examination, they will usually take a vaginal culture and send it to a lab for confirmation.2 There, the culture will be put on a slide and examined under a microscope.7

Females who have already been diagnosed with one or more yeast infections in their lives may be able to recognize the symptoms and determine when they have a yeast infection. It is extremely important, however, not to diagnose yourself if you have never had a yeast infection before or if you are at all unsure of your self-diagnosis. Symptoms of yeast infections often overlap with those of other infections.2 Because self-diagnosis is not always reliable, we do not recommend it; if you suspect that you have a yeast infection you should see your healthcare provider.

 

Treatment

Yeast infections may clear up on their own during a female’s menstrual period, because the pH of the vagina increases during this time, which can kill some of the yeast cells. However, yeast infections do not always clear up without treatment, and for some females the discomfort is so severe that they require immediate treatment.6

 

Yeast infections are treated with antifungal medication, and this treatment is generally simple and inexpensive. There are a variety of treatment methods available; you and your doctor will discuss which one is best for you. Some of the treatment options require a prescription, whereas others can be obtained over the counter.3 Treatments for vaginal yeast infections include the following:

  • A single dose of the oral medication fluconazole2
  • A three to seven day regimen of the antifungal clotrimazole, in one of the following forms:2
    • Antifungal cream
    • Antifungal ointment
    • Tablet that can be inserted into the vagina
    • Vaginal suppository

 

Some treatments are not appropriate for everyone. You and your healthcare provider will determine the best option for you based on your lifestyle and your medical history.

 

Generally, symptoms of yeast infections will subside after a week of treatment, but may take up to 14 days to fully disappear. It is important to follow up with your doctor to make sure that the infection is gone. You should also follow up if your symptoms do not ease up in two weeks, if you have another yeast infection within two months of the first one, or if you have recurring yeast infections (four or more in a year).2

 

Complicated yeast infections may require a different course of treatment:

  • A longer course of vaginal therapy (such clotrimazole in the form of a cream, ointment, tablet, or suppository); usually seven to fourteen days long3
  • Multiple doses of the oral medication fluconazole3
  • A maintenance plan3

 

A maintenance plan is a routine that females with recurring yeast infections follow to keep yeast levels under control and prevent future infections. Existing yeast infections must be treated before beginning the maintenance plan. Maintenance therapy usually consists of a weekly oral dose of fluconazole, but if oral therapy is not an option (such as in the case of pregnancy), a doctor will prescribe a weekly clotrimazole suppository. Maintenance treatment is usually six months long.3

 

Yeast Infections During Pregnancy

Yeast infections are more common during pregnancy than at any other time in a female’s life, and are especially common during the second trimester. During pregnancy, the body undergoes a wide variety of changes, including chemical changes in the vagina and vulva. For example, there is generally more sugar in the vaginal secretions of a pregnant female that yeast can feed on. This can allow the yeast to multiply and grow out of control.7

 

Yeast infections during pregnancy are not harmful to the mother or the fetus, but they can cause severe discomfort.8 It is extremely important to see a doctor if you are pregnant and think you may have a yeast infection, even if you have had experience with over-the-counter treatments in the past. You and your doctor need to consider and test for more serious conditions that could harm the fetus.8 It is vital to have a doctor confirm the diagnosis and prescribe the appropriate treatment. If left untreated, a yeast infection can pass to the baby’s mouth during childbirth, causing oral thrush.7

 

The oral medication fluconazole has not been proven to be safe during pregnancy and breastfeeding. Because of this, only vaginal creams and suppositories are recommended for pregnant or breastfeeding females. It may take 10 to 14 days for the yeast infection to clear up. Unfortunately, yeast infections are much harder to treat in pregnant females, and oftentimes will recur or will not respond to treatment. It is important for a female to follow up with her doctor to make sure the treatment is working, especially if her symptoms persist or worsen.7

 

Prevention

Yeast infections are a very common occurrence in females’ lives, and they are sometimes unavoidable. Still, there are some precautions that can be taken, including the following:

  • Avoid tight pants, pantyhose, tights, and leggings2
  • Avoid using scented/deodorizing pads and tampons6
  • Avoid hot tubs2
  • Avoid bubble baths7
  • Avoid douching2
  • Take off wet clothing and swimsuits as soon as possible6
  • Wear natural fibers/fabrics that are “breathable,” such as cotton, linen, and silk
  • Wear full coverage underwear rather than thongs8
  • Make sure your vaginal area is completely dry before putting on clothes8
  • Wipe from front to back after using the bathroom6
  • Wash underwear in hot water2
  • Change tampons/pads frequently6
  • Do not wear pads or pantiliners when you are not menstruating6
  • Eat a well balanced diet6 low in refined sugars and alcohols7
  • Get enough sleep, to allow your immune system to fight off infections better7
  • Try to lower your stress levels7

 

Yeast Infections in Males

Although yeast infections are traditionally considered to be a health issue for females, many males are also affected by genital yeast infections. Yeast infections are not well studied in males, so it is unknown how many males actually contract genital yeast infections.1

 

Causes

Males can become infected through sexual intercourse with an infected partner, or through a hormonal imbalance that allows Candida already present on the penis to increase in numbers. Yeast infections in males can be caused by any of the following:3

  • Antibiotic use
  • Corticosteroid use
  • Diabetes, especially if it is untreated
  • An impaired immune system
  • Poor hygiene

 

Uncircumcised males are at a higher risk of contracting yeast infections because the warm, moist area under the foreskin is the ideal environment for yeast to thrive.9

 

Symptoms and Diagnosis

Inflammation of the head of the penis is called balinitis, and the Candida yeast is responsible for 30-35% of cases of balinitis. This condition is called candidal balinitis or balinitis thrush, and if it also affects the foreskin of the penis, it is called candidal balanoposthitis.1 More commonly, genital candidiasis in men is simply referred to as a yeast infection.

 

It is extremely important for a male to see a doctor if he suspects that he might have a yeast infection. In males, symptoms of yeast infections can sometimes be very similar to those of herpes.4 A proper diagnosis from a doctor is essential. Symptoms of yeast infections in males include the following:

  • Small white spots on the penis4
  • Redness4
  • A dry, peeling rash4
  • Itching, irritation, and burning, especially while urinating or during intercourse3
  • Papules (small, rash-like bumps), which may or may not be pus-filled1
  • Clumpy white discharge from the urethra4
  • Discharge under the foreskin1
  • Difficulty pulling back foreskin1
  • Unpleasant odor1

 

Males who have previously been diagnosed with a yeast infection may treat themselves with over-the-counter creams such as clotrimazole, but if symptoms do not subside, they should see a doctor.

When you visit your doctor, he or she will start by taking a medical history, and then will physically examine the genitals. Doctors can usually diagnose a yeast infection just by interviewing the patient and performing an examination. If a doctor is unsure, he or she may swab the glans (head) and under the foreskin (if there is one) and send these cultures to a lab to be tested.9

 

 

 

Treatment

Yeast infections in males may go away by themselves, but if not, the infection could spread to the inner thighs, scrotum, or anus. The treatment for male yeast infections is very similar to that of female yeast infections. The infection can be treated either by a single dose of oral antifungal medication or by using a topical antifungal cream for three to seven days. Oral and topical treatments are equally effective, so deciding which to use is just a matter of preference and convenience.9

 

Prevention

Yeast infections in males and females have common causes. Thus, prevention of male yeast infections is very similar to that of female yeast infections. In order to prevent yeast infections, males can do the following:

  • Avoid baths and hot tubs9
  • Avoid using scented soaps, shower gels, and lotions on the penis9
  • Dry the penis carefully after showering or swimming9
  • Wear loose underwear made of natural materials to allow the genital area to get air flow9
  • Wash their penis under warm water every time they shower9
  • Wash under the foreskin (if it is present) to prevent fungus from growing9      

 

Yeast Infections and Sex

Sexual contact with an infected partner is one of the causes of yeast infections. Yeast infections can be passed through oral sex if the giving partner has oral thrush; likewise, performing oral sex on a partner with a genital yeast infection can lead to oral thrush. In some cases, a female can pass her infection to a male partner through penile/vaginal sex.5 It is very rare for a male to give his female partner a yeast infection through intercourse.  Partners may infect each other by sharing sex toys without cleaning them in between uses. For this reason, it is important to properly clean your sex toys before and after each use.5 Even though yeast infections can be passed from one sexual partner to another, they are not considered sexually transmitted infections (STIs) because there are many other causes of yeast infections.1

 

While yeast infections themselves are not associated with an increased risk of STIs, cuts and tears in the vaginal tissue from scratching or irritation can allow bacteria and viruses from STIs to enter the body. It is important to use a condom every time you have sex to prevent transmission of diseases.

 

The symptoms associated with yeast infections can make sex uncomfortable or even painful. Ideally, if you or your partner has been diagnosed with a yeast infection, you should abstain from sex until the infection has been treated. However, if you use a condom, there is a very low risk of passing a yeast infection to your partner. If treating your infection with vaginal creams, it is very important to not have sex until your treatment course is over, because sex can push the cream out of the vagina.

 

Anyone can get a genital yeast infection regardless of sex, gender, or frequency of sexual activity. Vaginal yeast infections are extremely common in females; yeast infections in males are less common, but still possible. It is important to be diagnosed by a doctor if you suspect you may have a yeast infection since other medical problems can mimic the symptoms of yeast infections. Although uncomfortable, yeast infections are easily treatable and a normal part of life. Contact your doctor or healthcare provider if you exhibit symptoms of a yeast infection.

 

 

Resources

1. Bennington, Joseph. “Yeast Infections in Males.” Everyday Health. Everyday Health Media, LLC, 9 September 2014. Web. 22 April 2016.

2. Johnson, Shannon. “Vaginal Yeast Infections.” Healthline. Healthline Media, 17 July 2015. Web. 10 April 2016.

3. Mayo Clinic Staff. “Yeast Infection (Vaginal).” Mayo Clinic. Mayo Foundation for Medical Education and Research, 18 September 2015. Web. 10 April 2016

4. Thaler, Malcolm M.D. “Males Get Yeast Infections, Too!” OneLife. One Medical Group, 30 March 2015. Web. 22 April 2016.

5. Vroomales-Durning, Marijke R.N. “Yeast Infections and Sex.” Everyday Health. Everyday Health Media, LLC, 2014. Web. 22 April 2016.

6. “Yeast Infection.” Brown Health Services. Brown University, n.d. Web. 12 April 2016.

7. “Yeast Infections During Pregnancy.” Americanpregnancy.org. American Pregnancy Association, n.d. Web. 18 April 2016.

8. “Yeast Infections During Pregnancy.” What to Expect. What to Expect, 16 April 2015. Web. 18 April 2016.

9. MacGill, Markus. “Thrush in Men (Male Candidiasis).” Medical News Today. Medical News Today, 2 December 2015. Web. 4 May 2016.

 

Last updated 1 June 2016