Vaginal yeast infections: all you need to know

Gynaecologist, Sumayya Ebrahim, educates us on vaginal candidiasis, also known as vaginal yeast infections, and its link to diabetes.

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Research has consistently shown that vaginal yeast infections are common in patients with both Type 1 and Type 2 diabetes. This is especially so if glucose control is not optimised.

Candida 101

Candida (or yeast) is a type of fungus that lives naturally in the body. We find it usually in the mouth, throat, gut and vagina. It also lives on the skin surfaces. Occasionally, when certain conditions exist in the body, this organism will multiply and cause an infection. This infection goes by the common name of thrush or candida.

What conditions favour the development of vaginal candida?

• Pregnancy – due to the hormonal changes
• Users of hormonal contraceptives
• Diabetes – especially if control is poor
• Recent antibiotic usage
• Weak immune system – from HIV, chemotherapy or any immune-related illness

Lifestyle factors

Candida loves a warm moist environment. Below are some lifestyle factors to get candida:

• Staying in a wet swimming costume
• Not changing sweaty gym clothes like lycra
• Using scented tampons
• Using a vaginal deodorant
• Unhealthy diet that consists of refined and processed foods and deficient in fresh fruits and vegetables

What are the symptoms?

Please note, vaginal candidiasis is not a sexually transmitted disease.

Symptoms can range from very mild to severe. In some instances, if the underlying problem is ongoing, the infection can recur frequently.

• Vaginal or vulva itching and irritation
• Sensation of burning during urination or intercourse
• Vaginal rash, tiny blisters or even cuts
• Redness and swelling of the vulva
• Vaginal or vulva pain
• Thick white vaginal discharge that resembles cottage cheese; this often has no odour

How is vaginal candida treated?

Treatment of vaginal candida involves either topical antifungal treatment like a cream to the skin or an ovule into the vagina. These are available over the counter.

Treatment usually lasts up to five days and resolves the problem. Oral antifungals are also available on script from your doctor. These can be used as an alternative for an early infection or be reserved for when candida recurs.

Prevention of vaginal candida

The best way to prevent vaginal candida infection is to avoid all the lifestyle factors that can act as triggers. In sufferers with ongoing diabetic challenges, the key strategy is good glucose control. Without good glucose control, candida overgrowth and symptomatic infection are never really kept in check.

Oral probiotics in the form of capsules or regular dietary unsweetened yoghurt with lactobacillus also prevents candida overgrowth.

Gynaecologists may also recommend vaginal probiotics inserted as a pessary directly into the vagina once or twice per week. This restores the good bacteria in the vagina called lactobacilli and allows the vagina to regulate its own pH. Thus, keeping it healthy. This in turn, helps to prevent ongoing or recurrent infection. A recurrent infection is said to occur if it happens more than four times per year.

Special considerations with diabetes

1. New research shows that a new group of drugs to treat Type 2 diabetes, called sodium glucose cotransporter 2 (SGLT2) inhibitors, makes users more prone to develop recurrent candida infections. These include dapagliflozin and empagliflozin.
2. Recent studies show that people with diabetes are more prone to having candida caused by strains different to the general population. In the general population, candida albicans is the most common yeast identified. In people with diabetes, the most common strain is candida glabrata; this strain has also been shown to be more resistant to successful treatment.

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