Treatment of yeast infection in Nigeria.
Yeast infection known medically as candidiasis, vaginal candidiasis , vaginal thrush, or vulvovaginal candidiasis is the commonest cause of vaginal discharge worldwide. In Lagos, Nigeria for example, the prevalence rate of Candida albicans (the causative organism of yeast infection) in all female genital swabs is about 18.7%. Yeast infection is commoner in pregnant than in non-pregnant women.
Yeast infection is caused by the fungus, Candida species. Candida organisms include: C. albicans, C. glabrata, C. tropicalis, C. pseudotropicalis, C. krusei and C. stellaloidea.
Candida albicans accounts for 60% to 80% of vaginal fungal infections; C.glabrata (20%), C. tropical is (6% to 23%). Two or more species can be found in an infection, with the combination of C. albicans, C.glabrata and C. tropical is being the most frequent. All the species are sensitive to antifungal agents but the non-albicans may be more difficult to treat.
Candidiasis may sometimes come on its own but most times our lifestyle choices, behaviours, drugs and health status makes us more prone to the infection. Below are factors that predisposes us to the disease.
Heat and moisture favour the growth of Candida spp and it is postulated that women who wear tight pants and trousers are more prone to candidiasis than those who wear skirts and loose fitting clothings. The reason women on antibiotics are more susceptible to yeast infection is the antibiotics kill off the other bacteria and thus remove the restraints to the growth of Candida spp. Antibiotics and steroids also depress the defense system of the body.
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It has been established that yeast infection can also be transmitted sexually though this is rare. Being an organism that is prevalent in the gastrointestinal tract the practice of oral and anal sex will perpetuate the infection. Yeast infection in males may cause symptomatic penile dermatitis.
Before we arrive at the drugs for the treatment of yeast infection in Nigeria, it is important we talk about the symptoms and signs of candidiasis.
Most patients in Nigeria complain of vaginal discharge. Vaginal discharge characteristic of candidiasis is usually profuse, thick, white, cheesy and forms plaques, which are found adherent to the vaginal wall. In women that douche, there may be no vaginal discharge at all. Other symptoms include vaginal itching, soreness and redness of the vaginal, pain during sexual intercourse, loss of interest in sex, burning/peppery feeling during urination. In some women, itching may occur before and after menses and remit at midcycle. Some other women may not have these symptoms but would be found to have florid vulvo-vaginal thrush when examined by the doctor.
The options for treatment include: intravaginal preparations and tablets. The available drugs for treatment of yeast infection in Nigeria may be;
A suppository is a solid dosage form that is inserted into the vagina or rectum where it dissolves to exert its effect.
The tablets may be taken orally or inserted into the vagina-please ensure you know the difference. These available drugs for the treatment of yeast infection in Nigeria include:
Clotrimazole: available as 100mg vaginal tablet taken for 7 days OR 1% cream, 5g intravaginally for 7-14days (the cream comes with an applicator), OR 200mg(2 tablets) inserted into the vagina for 2-3days.
Tioconazole: 6.5% ointment, 5g intravaginally in a single application.
Nystatin: 100,000 unit inserted high into the vagina each night(can be during the day) for 14days.
Butoconazole: 2% cream, 5g intravaginally for 3 days.
Miconazole: 1200mg vaginal suppository, 1 suppository for 1 day OR 100mg vaginal suppository, 1 suppository for 7 days OR 200mg vaginal suppository, 1 suppository for 3 days.
Terconazole: 0.4% cream, 5g intravaginally for 7 days.
Gentian violet: 1% or 2% gentian violet solution painted over the vagina and vulva is effective but stains the underpants and may not be aesthetically acceptable to the patients.
Boric acid: The use of boric acid for the treatment of yeast infection in Nigeria has been discarded.
The oral medications include: ketoconazole, itraconazole and fluconazole (diflucan) and nystatin.
Fluconazole (diflucan) is taken as 150mg oral tablet, 1 tablet in a single dose.
1. Yoghurt: When proven remedy. When who eat yoghurt have been found to be less prone to having yeast infection. The yoghurt increase the acidity of the vaginal which is not a good growth media for Candida.
2. Garlic: garlic has been shown to be effective against yeast infection. It works in a similar way as yoghurt.
Moringa, ginger, apple cedar, and bitter leaf juice have been propounded by some native practictioners to cure yeast infection in Nigeria but it is not proven. I strongly do not recommend it.
Yeast infection becomes chronic or recurrent when you have four or more symptomatic episodes in a year. It can be difficult to treat. The following may be responsible:
2. Noncompliance with medication
3. Re- infection from infected partner
5. Drug resistance
6.Yeast infection caused by a different strain of candida albicans.
You need to see a doctor for recurrent yeast infection. A careful history will be taken from you. You will be screened for diabetes and counselled for HIV screening. Recurrent candidiasis may be the first presenting symptom if HIV infection in women.
In patients with recurrent yeast infection, prolonged treatment like vaginal clotrimazole (100mg) daily for 6 days in a month, vaginal clotrimazole (500mg) once a month for 6 months, is rewarding. Oral fluconazole (150mg) weekly for 1 month or oral nystatin (500,000units) four times daily for 10days may be used.
Infected sexual partner should be treated.
PLEASE NOTE THAT THIS ARTICLE IS NOT A SUBSTITUTE FOR SEEING A DOCTOR.
Obstetrics and Gynaecology by Akin Agboola
This post was last modified on January 16, 2019 7:13 pm