Yeast Infections (Vaginal Candidiasis)

Your immune system, hormones, and "friendly" bacteria in your vagina all play an important role in keeping your vagina lubricated and healthy. Changes in your immune status, hormonal balance, or the amount of bacteria in your body can result in a range of vaginal symptoms, including yeast infections.

Yeast infections are overgrowths of a fungus called candida, normally found in small amounts throughout your body. When there's too much candida, your vagina can become inflamed or painful. You may see a thick, white, itchy discharge around your vagina, labia, or anal area.

Antibiotics, steroids, birth control pills, and foods high in sugars or starches (breads, pastas, and alcohol) all promote the growth of yeast. So can douching, which reduces levels of "helpful" bacteria in your vagina and is not recommended for women with HIV. In positive women, recurrent yeast infections are often the result of immune suppression. You're more likely to develop these infections, or see them return after treatment, if you have a decreasing CD4 count.

Many women self-diagnose and treat yeast infections with over-the-counter anti-fungal creams like Monistat or Gyne-Lotrimin. Creams come in different strengths and are used for 3 to 10 days depending on the formulation. Positive women often need longer courses of treatment with anti-fungal drugs, or prescription-strength creams. Your provider can recommend the right strength for you (3% or 5%, for example).

Some yeast infections just don't respond to topical creams. This is more likely if your CD4s are low, if you use over-the-counter drugs frequently to treat yeast infections, or you don't finish the full course of treatment. For difficult-to-treat infections, your doctor can prescribe oral antifungal drugs such as Nizoral (ketoconazole), Diflucan (fluconazole), or Sporanox (itraconazole). Keep in mind that drugs taken by mouth reach far more parts of your body than a cream or suppository, can interact with HIV medications, and sometimes cause side effects.

Since yeast infections can resemble bacterial infections sometimes seen in positive women, it's a good idea to see your GYN if you notice any unusual discharge or odor -- especially if you've already tried over-the-counter drugs and you're still having symptoms. Your gynecologist may collect a sample of your discharge to make sure it's just yeast that's causing the inflammation. A similar vaginal sample can show whether you have healthy levels of acid in your vagina (called vaginal pH). If your pH levels are too high or too low, your doctor may suggest simple remedies to help restore a healthier vaginal pH level.

Since HIV can lead to a number of vaginal conditions, consider dietary and other changes that will support your overall vaginal health. Dietary changes include less sugars and starches, more soy products, and a multivitamin supplement. If you take antibiotics or birth control pills, you may also want to consider acidophilus supplements to restore supportive bacterial levels in your vagina. Try to wear loose, cotton underwear and clothes that won't trap moisture in your vagina. You may also want to steer clear of chemicals (found in scented soaps, detergents, douches) that throw off the vaginal pH. Douching can change bacterial and fungal levels in your vagina and should be avoided unless your provider specifically recommends it.