What Is Vaginal Yeast Infection? Why It Keeps Coming Back?

Vaginal yeast infection is a common health issue that affects most women at least once in their lifetime. Although not typically dangerous, it can significantly impact quality of life if not properly diagnosed and treated. Common symptoms like itching, burning, and abnormal discharge often cause confusion and concern—especially regarding whether it’s sexually transmitted.

This article provides a comprehensive overview of vaginal candidiasis, covering its causes, symptoms, diagnosis, treatments, prevention strategies, and frequently asked questions to help women take control of their intimate health.

What Is a Vaginal Yeast Infection?

A vaginal yeast infection, medically known as Vaginal Candidiasis or Vulvovaginal Candidiasis, occurs when the fungus Candida overgrows in the vagina.

Normally, small amounts of Candida live harmlessly in the vagina, kept in check by healthy bacteria. However, when this balance is disrupted—due to antibiotics, hormonal changes, or other factors—the fungus multiplies, causing inflammation, itching, redness, and a thick “cottage‑cheese” vaginal discharge.

This condition is very common in women of reproductive age: about 75% experience it at least once, and 40–45% experience recurrent episodes.

Why Does Vaginal Yeast Infection Keep Coming Back?

A vaginal yeast infection is classified as Recurrent Vulvovaginal Candidiasis (RVVC) when it recurs at least 3 times in 12 months or 4 times per year. Even after treatment, about 5–8% of reproductive‑age women will experience recurrent infections.

Key reasons for recurrence include:

1. Drug‑resistant Candida strains, such as non‑albicans species (e.g., C. glabrata, C. tropicalis), which are less responsive to azole treatment.
2. Incomplete treatment, often due to inconsistent use of topical medication or stopping therapy prematurely.
3. Host risk factors, like frequent antibiotic use, hyperglycemia (diabetes), or weakened immune system.
4. Genetic susceptibility, such as inadequate immune response to Candida colonization.
5. Re-infection from sexual partners, as some studies show identical strains in partners.

Common Symptoms of Vaginal Yeast Infection

Symptoms range from mild to moderate, and some women may even have no noticeable symptoms. Common signs include:

• Itching or irritation in the vagina and vulva, which may worsen when wearing tight clothing.
• Thick white “cottage‑cheese” vaginal discharge, typically odorless.
• Burning during urination or intercourse, due to irritated tissue.
• Redness, swelling, or fissures around the vulva, especially in more severe or recurrent cases.

When to See a Doctor Right Away:

• First-time symptoms with no prior history.
• Symptoms persist beyond 7–14 days despite treatment.
• Abnormal discharge that is yellowish, greenish, or has a strong odor.
• Fever, lower abdominal pain, or severe discomfort accompany symptoms.
• Recurrent infections occurring multiple times within a year.

Differences Between Yeast Infection, STIs, and Other Vaginal Infections

1. Yeast Infection (Candidiasis)

• Cause: Candida fungus, especially C. albicans.
• Discharge: Thick, white, cottage-cheese-like; typically odorless.
• Other Symptoms: Itching, irritation, burning during urination or intercourse; possible redness or swelling.

2. Bacterial Vaginosis (BV)

• Cause: Overgrowth of bacteria (e.g., Gardnerella vaginalis), not fungal.
• Discharge: Thin, gray/white/yellow with fishy odor—often worse during menstruation or after sex.
• Other Symptoms: Little to no itching, minimal inflammation.

3. Trichomoniasis

• Cause: Parasite Trichomonas vaginalis—a sexually transmitted infection.
• Discharge: Thin, yellow/green, often foul-smelling.
• Other Symptoms: Genital itching, burning with urination/sex, “strawberry cervix” (red spots on cervix).

Comparison Table

How Is Vaginal Yeast Infection Diagnosed?

Diagnosis involves two major steps:

1. Clinical evaluation & history-taking
   • The provider asks about past infections, antibiotic use, or STIs.
   • A pelvic exam is performed to check the appearance of the vaginal walls and discharge.
2. Laboratory tests
   • Wet mount / KOH smear: Vaginal discharge mixed with KOH is viewed microscopically to detect yeast spores and pseudohyphae.
   • Vaginal pH measurement: A pH <4.5 supports yeast infection; elevated pH suggests BV or trichomoniasis.
   • Culture / PCR: Recommended for severe, recurrent, or treatment-resistant cases—especially if non-albicans species (C. glabrata) are suspected.

Guideline recommendations:

• For recurrent infections (≥3/year), culture and antifungal susceptibility testing are advised to tailor therapy.
• Culture remains the gold standard, and PCR-based diagnostics are increasingly adopted.

How to Treat Vaginal Yeast Infection (OTC & Prescription)

Treatment options fall into three main categories: topical OTC, oral prescription, and special therapies, depending on symptom severity.

1. Topical OTC Antifungals

Effective for uncomplicated cases.

• Clotrimazole, Miconazole, Tioconazole, Terconazole, Nystatin in creams or vaginal suppositories for 1–7 days.
• Relieves itching, burning, and abnormal discharge within a few days.

2. Oral Prescription Antifungals

Recommended for severe or recurrent infections.

• Fluconazole (Diflucan)
  • Single 150 mg dose for uncomplicated infections.
  • Severe cases: 150 mg every 72 hours for 2–3 doses.
  • Recurrent cases: 10–14 days induction, followed by 150 mg weekly for 6 months.
• Ibrexafungerp (Brexafemme)
  • First non-azole oral option; 2 tablets in one day, ideal for azole-resistant or allergic patients.
• Oteseconazole (Vivjoa)
  • Approved specifically for recurrent VVC in non-reproductive adults; reduces recurrence notably in clinical trials.

3. Special Therapies

• Non-albicans Candida (azole-resistant): Use boric acid 600 mg vaginally once daily for 14–21 days, or as maintenance therapy
• Chronic cases: Consider nystatin, flucytosine, or amphotericin B creams based on clinical discretion.

4. Treatment During Pregnancy

• Prefer clotrimazole or nystatin vaginal formulations for 7–14 days, considered safer than oral antifungals.

Precautions

• For recurrent infections, CDC recommends inducing remission then weekly maintenance for 6 months.
• OTC topical antifungals should be used as directed; if symptoms persist beyond 7–14 days or recur, seek medical evaluation.

Aftercare and Preventing Recurrence of Yeast Infection

Once symptoms resolve, follow these steps to maintain vaginal health and prevent recurrence:

1. Maintain genital hygiene.
   • Wash with water or pH-balanced cleansers (free from preservatives/fragrances).
   • Pat dry thoroughly after bathing.
2. Wear breathable, loose clothing.
   • Avoid tight pants, synthetic underwear, or non-ventilating fabrics.
3. Change underwear and towels frequently.
   • Replace twice daily and avoid sharing linens or undergarments.
4. Control behavioral and health risk factors.
   • Avoid unnecessary antibiotic use.
   • Manage blood sugar in diabetic individuals.
   • Minimize use of hot tubs and unclean swimming pools.
5. Opt for probiotic-rich diets.
   • Consume yogurt with Lactobacillus acidophilus.
   • Reduce sugary and refined-carb intake to inhibit yeast growth.
6. Use maintenance antifungal regimens for recurrent cases.
   • For recurrent VVC per CDC: take 150 mg weekly Fluconazole for up to 6 months.
   • For non-albicans resistant strains, boric acid 600 mg vaginal suppository 2–3/week can be used.

When Should You See a Doctor Immediately? What Complications Can Yeast Infection Cause?

Seek prompt medical attention if you experience any of the following:

• First-time symptoms with no clear cause.
• Symptoms persist despite 7–14 days of OTC treatment.
• Abnormal discharge with yellow/green color, or strong odor.
• Fever, lower abdominal pain, or intense discomfort involving the vagina.
• Multiple recurrences within a year.
• Pregnancy with symptoms, or underlying immune-suppressing conditions.

Possible Complications:

• Upper reproductive tract infections, including ovarian cysts or pelvic inflammatory disease (PID), which may impact fertility.
• Drug-resistant Candida strains, emerging from improper treatment or repeated infections, requiring specialist antifungals.
• Pregnancy-related risks, such as preterm birth or low birth weight babies.
• Reduced quality of life, with recurrent itching and burning affecting daily activities and sexual relationships.

Frequently Asked Questions About Vaginal Yeast Infection

Q1: Is vaginal yeast infection considered an STI?
A: Generally, no; it isn’t classified as a sexually transmitted infection. However, yeast strains may be shared between partners, so if symptoms persist or recur, both partners should be evaluated.

Q2: Can tampons help reduce yeast?
A: Not recommended. Tampons absorb moisture and can create a warm, damp environment conducive to yeast growth. Change frequently and opt for breathable alternatives.

Q3: Is it okay to have sex during a yeast infection?
A: It’s best to avoid intercourse while symptomatic as it may worsen irritation or lead to reinfection. Resume sex after treatment and symptom resolution.

Q4: Can pregnant women use OTC antifungals?
A: Vaginal creams or suppositories like clotrimazole and nystatin are generally safe in pregnancy, but always consult a healthcare provider first.

Q5: Should I treat mild itching immediately?
A: For mild symptoms, try self-care—wear loose clothing, maintain hygiene, and wait 3–5 days. If symptoms worsen or persist, especially with burning or abnormal discharge, seek medical attention.

Conclusion

Vaginal yeast infections are usually caused by microbial imbalance rather than being sexually transmitted. While treatable, recurrence is common, especially in individuals with certain risk factors or poor hygiene practices.

Timely and accurate diagnosis, proper treatment, and consistent aftercare are essential to preventing recurrence. With the right knowledge and self-care, women can maintain their vaginal health and improve overall well-being sustainably.

• Facebook
• Twitter
• Line