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Vaginal Health

Summer 2011

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Debbie Kelly, Pharm.D., Pharmacist, Newfoundland and Labrador HIV Clinic, St. John's

In most cases, treatments for yeast infections are the same for all women regardless of whether or not they have HIV. I tend to recommend antifungal creams and ovules (such as Monistat) over the single fluconazole tablet as a first treatment because we don't want to create instances of fluconazole resistance. If you are taking fluconazole tablets regularly as a preventative measure -- which is more common when yeast infections affect the mouth or throat rather than the vagina -- your HIV doctor will want to check for interactions between fluconazole and anti-HIV medications.

Bacterial vaginosis is usually treated with the antibiotic metronidazole (Flagyl). It can make you viciously sick if you drink alcohol while taking it, so try to avoid alcohol while taking this drug and for two to three days afterwards. If this is impossible, ask about the antibiotic clindamycin. Be aware that metronidazole, clindamycin and some other antibiotics can disturb the natural balance of bacteria in the vagina and may increase the risk of yeast infections. Clindamycin can also cause diarrhea, especially if you are already having a problem with this due to anti-HIV medications.

Herpes simplex virus outbreaks are often more severe, last longer and may recur more often among people with HIV. I send my patients home with antiviral medications prior to their outbreaks so they can begin their meds the moment they spot a new lesion or feel the tingling that precedes one. This really helps get painful flares under control.

Two herpes medications, acyclovir (Zovirax) and valacyclovir (Valtrex), may increase levels of tenofovir (Truvada and in Atripla), so your doctor should monitor you for adverse effects if you are taking either of these drugs for a long time. They can also affect kidney health.


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Cheryl Collier, R.D., Clinical Dietitian, Oak Tree Clinic, Vancouver

Reams of information exist in the media about using the "Candida diet" to prevent or treat yeast infections. Advocates of this high-vegetable, high-protein diet advise people to avoid simple sugars as well as other foods including some dairy products, fruit, starchy vegetables and starchy foods, such as gluten-containing grain products (anything made from wheat or related cereals such as barley and rye). Evidence does not show that cutting out all these different foods can prevent or treat yeast infections, though limiting added sugars and refined carbohydrates is always a healthy practice. I encourage women with HIV to consider that a balanced diet is important for getting all essential nutrients needed for good health.

Women with uncontrolled diabetes are at increased risk for developing recurrent yeast infections. For this reason and others, it is important to get diabetes under control, which includes working closely with a doctor. HIV-positive women with uncontrolled diabetes are encouraged to eat balanced regular meals, choose higher-fibre foods and limit refined carbohydrates to help manage their blood sugars. This, along with other strategies, such as regular physical activity and taking diabetes medications as prescribed, will hopefully help keep blood sugars under better control and decrease the risk of recurrent yeast infections.

There is more and more interest in the effect of probiotic preparations on preventing or treating yeast infections and treating bacterial vaginosis. Although this is a growing area of research, not enough evidence currently exists to show that they do this. It is a difficult area to research because studies are often small and the probiotic treatments being studied can be quite different. More high-quality research is needed to better understand the role of probiotics in treating vaginal infections.

Finally, women going through menopause should drink enough fluids to stay well hydrated and help ward off vaginal dryness. This applies to all women, but it bears repeating because it is so important and yet easily forgotten during a busy day. Talk with a healthcare provider, such as your family doctor, nurse or gynecologist, if you have vaginal dryness.


Herbal Interactions

Some herbs interact with prescription medicines, including anti-HIV drugs and over-the-counter products. This can change the medication's effectiveness or intensify its side effects. Be sure to let your doctor know about all the herbs, supplements and other complementary therapies you take.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
 
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