Candidiasis

Genital candidiasis Infections: What You Really Need to Know

If you suffer from chronic vaginal itching and have thought it might be due to a recurring candidiasis infection, this post is for you. There's a lot of misinformation circulating about fungus infections, so let's break down what we really know and what the science backs up.

Is it really cadidiasis?

 It's understandable to think that vaginal itching is synonymous with a candidiasis infection, especially if you've read that thick, white discharge is a sure sign of infection. But here's a key truth: the appearance of vaginal discharge is not a reliable criterion for diagnosing candidiasis. You can have a severe infection with hardly any discharge, or you can have a large amount of white, clumpy discharge without a fungus infection.

In fact, about 50% of people who self-diagnose a candidiasis are wrong. This is because the symptoms can be confused with other conditions, such as bacterial vaginosis, lichen sclerosus, or even vulvar eczema.

Keys to an Accurate Diagnosis

Diagnosing a candidiasis based solely on symptoms or the appearance of the discharge is not enough. The most reliable method for diagnosing a yeast infection is a vaginal culture. This test confirms the presence of fungus and determines the exact type, which is crucial if the problem recurs.

If you have recurrent infections, it is essential to perform a culture before continuing with antifungal treatments. In some cases, the problem is not the candidiasis itself, but rather a disturbance in the balance of the vaginal ecosystem or an underlying skin condition.

Follow-up is essential. After 4 weeks, if the patient has not fully improved, a re-evaluation is necessary. At this point, there are two possibilities:

• The fungus is resistant to treatment. The culture will be positive, and sensitivity testing should be performed to determine the appropriate medication.

• The yeast was never the cause of the symptoms, or it wasn't completely causing them. If the culture is negative but symptoms persist, then the problem lies somewhere else.

Why does yeast infection keep coming back?

If you do have recurrent candidiasis, there are several reasons why this could be happening:

1. The vaginal ecosystem hasn't fully reestablished itself. Some people have a vaginal microbiome that's more susceptible to yeast growth.

2. Underlying risk factors. Uncontrolled diabetes, frequent antibiotic use, or immune problems can make episodes more frequent.

3. Antifungal resistance. Some Candida species are naturally resistant to fluconazole and other common treatments, causing the infection to persist. In this case, the infection never cleared up because the medication didn't work. Some types of Candida are naturally resistant to oral and over-the-counter antifungals, while other strains can develop resistance over time. To diagnose this, a culture with sensitivity testing is needed.

• If the culture shows Candida kruseii, we know that fluconazole won't work, but clotrimazole might.
• If the culture shows Candida albicans (the most common cause of yeast infections), the lab must perform tests to determine which medication will be effective.

Once we have these results, we can design the appropriate treatment.

4. Skin conditions that facilitate infection. Problems such as lichen simplex chronicus or lichen sclerosus can disrupt the skin barrier and facilitate fungal growth.

Sometimes, a skin condition can occur alongside a candidiasis.

Skin conditions damage the skin barrier, making it more vulnerable to fungus. This can be difficult to distinguish because, at any given time, 20% of people have fungus in their vagina without symptoms. This means that a positive culture does not always indicate an infection.

An infection occurs when the fungus overgrows and causes symptoms, but a culture cannot differentiate between normal colonization and an active infection.

• If there are signs of vaginal inflammation, candidiasis infection is more likely.
• If there is clear evidence of a skin problem and a positive fungal culture, we typically treat both.

Effective Treatment: Beyond Antifungals

If recurrent candidiasis is confirmed, the recommended treatment is usually suppressive fluconazole, i.e., taking it regularly for several months to prevent relapse. This protocol has proven effective for many people.

But if treatment doesn't work, it's critical to reevaluate the diagnosis: Is it really candidiasis, or is another condition causing the symptoms?

What DOESN'T work, or at least, there isn't much scientific evidence to support it.

There are many myths surrounding candidiasis. Here are some approaches to the topic, which have not been proven to have good scientific evidence to support them.

• Diet does not influence candidiasis. There is no evidence that eliminating sugar or certain foods helps.
• Probiotics, so far, have not shown great effectiveness in preventing or treating candidiasis.
• Vaginal microbiome tests. Until there are studies that support them, they cannot be considered useful diagnostic tools.
• Boric acid does not regulate vaginal pH. Its use is only indicated in cases of candidiasis resistant to standard treatments, always under medical supervision.

When to consider other causes

If the fungus culture is negative but you continue to have chronic itching, it may be time to evaluate other conditions such as:

• Iron deficiency or thyroid problems. Both can cause vulvar dryness and itching.
• Inflammatory skin conditions such as lichen sclerosus or lichen simplex chronicus.
• Bacterial vaginosis, which can cause irritation and changes in vaginal discharge.

Conclusion

If you feel that candidiasis are a recurring problem in your life, the key is to get a correct diagnosis before continuing to try treatments without certainty. A vaginal culture, a thorough evaluation of your symptoms, and ruling out other underlying causes are essential steps to finding the right solution.