Published May 19, 2005 in issue 0420 of the Hook

BY JOHN HONG, MD

I love musicals. I know every Rodgers and Hammerstein musical and every obscure song they wrote. If you ever hear me sing Karaoke, you will know what I mean. "I can name and sing that song in 4 notes..."

However, I don't know enough musicals-- like Candide-- by one of my favorite composers, Leonard Bernstein. Would I have learned it in medical school if he composed a musical Candida?

Candida is a fungal species, aka "yeast." Most vaginal yeast infections are caused by Candida albicans, which for some strange reason always makes me think it should be a province in Canada or a type of tuna fish.

Candida, like many types of bacteria, is pretty often found in healthy people's mouths, GI tracts, and vaginas (well, if you're a woman). Candida normally lives in harmony with bacteria in the body, sort of the way Rodney King would like it, "Can't we, can't we... all get along?"

However, if there's a riot that wipes out some of the bacteria, Candida becomes an imperialist and invades the healthy cells of the body, like the vagina.

This is why women who have taken antibiotics sometimes get a yeast infection following treatment. The antibiotics wipe out bacteria in the vagina, and Candida becomes an imperialist to infect the vaginal lining. (That's also a reason not to douche.)

Yeast infections are pretty common in women: at least 75 percent of women have had at least one infection in their lifetime. Itching is the main problem in a yeast infection, as well as discharge, irritation, burning with peeing, and "a-bad-time-with-da-man."

Usually, a yeast infection is an annoyance, and treatment is as easy as Britney Spears getting married. In fact, most women don't see the doctor because there are plenty of over-the-counter medicines. But what if a woman has repeated yeast infections? Ouch!

Unfortunately, five percent of healthy women have recurrent yeast infections (four or more episodes per year). Increased estrogen levels, caused by birth control pills, pregnancy, and estrogen therapy, can make a woman prone to recurrent yeast infections. Women have more estrogen floating around before their period, so that's why yeast infections most often occur during the PMS phase. And you just thought it was because you were grouchy!

Diabetes, HIV, IUDs, diaphragms, and steroids all can cause recurrent yeast infections as well. Genetically, some women lack vaginal immunity against yeast infections. Studies have also shown that pantyliners, pantyhose that cover the pelvis, and sexual lubricants increase the risk of yeast infections. You know, Madonna wore her panties on the outside. I wonder if she had fewer yeast infections? (That doesn't explain why Michael Jackson wore the thong on the outside, though.)

Yeast infections are not an STD and are not related to sexual activity. I know someone whose mother said, "Young lady, you're having sex, aren't you? How else are you getting these yeast infections?" Little did mom know that her daughter was as virgin as first-press olive oil.

Over-the-counter creams, such as clotrimazole, have a 97 percent success rate. Prescription fluconazole (150mg taken just one time) has a 94 percent success rate. However, if the yeast infection is due to Candida glabrata instead of Candida albicans, the oral medication is less successful. (Sorry, but Candida glabrata sounds like an opera singer to me.)

Boric acid vaginal suppositories tend to work better on glabrata. Acidophilus might be helpful, though it hasn't been proven scientifically.

Talk to your doctor and get an examination. A slide of vaginal secretions seen under the microscope is worth a thousand words. Itching and irritation should be the yeast of your concerns.

Got a medical question? Dr. Hook wants to hear from you.

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