Upstream Health Solutions

A growing number of women are plagued by vaginal yeast infections that resist treatment. Read about this chronic condition known as RVVC.

Approximately 75% of all women have experienced vulvovaginal candidiasis (VVC) at least once in their lifetime. The VVC infection, commonly referred to as a “yeast infection,” is caused by an overgrowth of the Candida fungus in the genital area. The fungus is normally present in the body in small amounts; it lives in warm, moist areas, such as the mouth, the gastrointestinal tract, and the vagina. This natural presence of the organism does not cause symptoms – but certain predisposing factors can allow it to multiply, resulting in vaginal itching, soreness, and discharge.

The occasional yeast infection is common, and is usually easily treated with antifungal medications. But a growing number of women are plagued by yeast infections that resist treatment, or tend to recur. This chronic condition is known as RVVC: recurrent vulvovaginal candidiasis.

Understanding Yeast Infections:

RVVC is defined as four or more vaginal yeast infections in a given year. But it is important to understand the difference between a new infection, and one that has lingered due to improper treatment. With the increasing availability of over-the-counter medications for VVC, more women are attempting self-diagnosis and self-treatment. Yeast infection symptoms can be similar to those of several other genital conditions, including bacterial vaginosis, and urinary tract infections. What appears to be a yeast infection that “won’t go away,” may actually be something else entirely. For these reasons, it is advisable to seek diagnosis from a licensed healthcare provider – this usually involves taking a vaginal swab and testing the specimen for the presence of Candida.

Before we discuss the problems of RVVC further, let’s first take a look at yeast infections in general:

Symptoms of yeast infection can include vaginal itching or burning; redness and swelling of the labia; a thick, white discharge; painful or difficult urination; and painful sexual intercourse. In severe cases, the skin around the vaginal opening may become cracked and bleed.

Causes: Overgrowth of the Candida fungus can occur when there is a change in the normal acidity of the vagina, or during a change in a woman’s hormonal balance. Stress, poor diet, illness, lack of sleep, menstruation, and pregnancy, are all conditions that can lead to these changes. Wearing tight clothing around the genital area can also induce infection, because heat and moisture become trapped, creating an optimal environment for yeast to thrive.

Yeast infections are common in women with diabetes, and those that have a weakened immune system. Women who are taking antibiotics, or corticosteroid medications are also at high risk. These medications can kill the “friendly bacteria” that normally live in the vagina. The bacteria are capable of destroying the yeast fungus, keeping it in balance.

Although rare, sexual transmission of Candida can occur. Men can also become infected, and may develop an itchy rash on the penis. In some instances, a physician may advise that a woman’s partner be simultaneously treated for the infection.

Treatment: Antifungal medications for genital yeast infections are available in over-the-counter creams and vaginal suppositories. Oral medications, such as fluconazole, are also available by prescription. These treatments are effective in curing the infection with an 80%-90% success rate. But, as mentioned earlier, infections that don’t respond well to treatment are becoming more common. Approximately 5% of women who experience a yeast infection will develop RVVC.

Potential Causes of RVVC:

The causes of RVVC are not well understood — although diabetes, HIV infection, and the prolonged use of antibiotics or corticosteroid medications may play a significant role. But in many cases, no obvious explanation exists for recurrent infections.

Some early research was done to suggest that RVVC is caused by the continual presence of Candida in the intestinal tract, which then reinfects the vagina. But later studies have shown little difference in the amounts of gastrointestinal Candida in women who have RVVC and those who do not.

Another theory is that a woman becomes reinfected via sexual relations with her partner. But studies in which both partners were treated for the infection showed that treatment of the partner had no effect on the woman’s risk for recurrent infections.

New research is focused on the idea that women with RVVC may have an abnormal vaginal immune response to yeast. In other words, some women’s bodies may not have the natural ability to control growth of the Candida fungus. And since a small amount of the organism will likely remain in the vagina, even after treatment, the risk for infection is constantly present.