Gynecological conditions and HIV / AIDS

October 2005     View PDF     En español

Vaginal Candidiasis

Yeast is a common fungus that normally exists in your body. Vaginal candidiasis is an overgrowth of that yeast in the vulva and vagina. Many things can disrupt the natural balance of the vaginal environment and cause a yeast infection. They can include taking antibiotics, birth control pills, steroids, pregnancy, obesity, diabetes and poor hygiene.

For HIV-positive women, yeast infections are the most common first symptom of HIV. Repeated yeast infections and those that respond less well to treatment over time are signs of a weakening immune system. As CD4+ cell counts fall below 200, the risk increases for repeated yeast infections to occur in the vagina, mouth and throat (esophagus).

Symptoms of vaginal candidiasis include itching and swelling of the vulva, thick white-yellow or cheesy discharge and burning while urinating or having sex. As the immune system weakens, the main place of the yeast infection may move from the vagina to the mouth or esophagus. It can also affect organs and tissues throughout the body (this is called disseminated or systemic candidiasis).

There are several ways to treat vaginal candidiasis, including creams and suppositories like clotrimazole (Gyne-Lotrimin). You can purchase these both over-the-counter and by prescription. If the candidiasis does not respond to local (at the site of infection) treatment, fluconazole (Diflucan) or ketoconazole (Nizoral) are usually effective. These pills are taken orally and treat fungal infections throughout the body (systemically).

Several studies caution that women with low CD4+ counts (below 50) who have used fluconazole extensively are more likely to develop candidiasis that is resistant to fluconazole, (a very potent and effective anti-fungal treatment). Many advise using local treatments first, keeping systemic therapies like fluconazole as a back-up if fungal infections become more serious and/or life-threatening.

Some anti-fungal drugs (called azoles) have been shown to cause birth defects in animal studies and as a result are not recommended for use by pregnant women. For more information, read Project Inform’s publications, Oral Candidiasis, Vaginal Candidiasis, and Systemic Candidiasis.

Tips that may help prevent yeast infections

• Change your diet. Sugar is like food for yeast. Some women decrease their sugar intake, decrease caffeine, add yogurt with lactobacillus to their diets (check the label), or take acidophilus capsules (available in health food stores).
• Avoid douching. Douching changes the vagina’s natural acid level (called pH level) and can cause inflammation. Both may increase the risk of getting other infections, including STDs. Douching can also push infections further up into the GYN tract. Your body has a natural douching system—let it work!
• Avoid scented laundry soap, bleach and fabric softeners. Scented laundry soap contains chemicals that can make a yeast infection worse. Residual bleach in your clothing may destroy healthy bacteria that help keep fungal infections at bay. Fabric softeners block moisture absorption, causing moist areas of the skin to stay damp, thus encouraging growth of bacteria and fungi, etc.
• Avoid wearing tight clothes. They block air flow, creating a damp place on your skin. Yeast infections grow best in moist places. Loose clothing allows air to flow and provides a dryer environment.
• Wear cotton underwear. Unlike synthetics such as polyester, lycra and nylon, cotton fabric lets air in and doesn’t trap moisture.
• Avoid washing the vaginal area with deodorant soaps. Some women claim that when they stop using scented soaps, yeast infections heal better and don’t repeat as often. This includes avoiding bubble baths.
• Try a non-soap cleanser. Soap can dry the skin and can worsen the condition of the vaginal area affected by a yeast infection. Non-soap cleansers can be found at many health food stores and supermarkets. Some of these products contain natural ingredients that might help control infections and promote skin healing.