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Candidiasis

Also listed as: Yeast infection

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Following Up
• Special Considerations
• Supporting Research

Candidiasis is an infection caused by a yeastlike fungus called candida. It can infect the mouth, vagina, skin, stomach, and urinary tract. About 75 percent of women will get candidiasis of the vagina during their lifetime, and 90 percent of all people with HIV/AIDS develop candida infections.

Signs and Symptoms

• Creamy white patches in the mouth or on the throat
• Painful cracks at the corners of the mouth
• Skin rashes, patches, and blisters found most commonly in the groin, between fingers and toes, and under the breasts
• Vaginal itching and irritation with a curdlike discharge

What Causes It?

Normal amounts of candida existing in the mouth, stomach, and vagina do not cause infections. Candidiasis occurs when there is a buildup of candida. Causes may include taking certain drugs (especially antibiotics), pregnancy, being overweight, bacterial infection, or several different health conditions (for example, immune disorders, diabetes, and psoriasis).

What to Expect at Your Provider's Office

Your health care provider may take samples for testing (for example, a vaginal wet smear) and do extensive tests (such as a CT scan or test of your stool) if it appears that the infection has spread. Your health care provider may prescribe antifungal medication and recommend dietary changes. These treatments usually cure candidiasis. If you have recurrent bouts of candidiasis, your provider will explore the possibility of an immune deficiency or some other disease.

Treatment Options

Drug Therapies

Many antifungal medications are available to treat candidiasis. Your health care provider will prescribe a drug depending on the location and severity of your disease.

• Antifungal medications -- include oral rinses and tablets, vaginal tablets and suppositories, and creams. Side effects vary.
• Antibiotics -- cure certain types of candida.
• Topical vaginal creams and suppositories.
• Creams combined with low-strength corticosteroids -- reduce inflammation and itching.

Most treatments last from 2 - 3 days to 2 weeks. Be sure to take all medicine exactly as prescribed. If you do not, the same infection could come back. Reinfection with a new strain of candida also can occur. For more severe candidiasis, you will receive fluids and electrolytes through an IV.

Some topical vaginal creams and suppositories are available over the counter and may be used for 1 - 7 days. See your provider if the condition persists.

Complementary and Alternative Therapies

Some studies indicate that reducing sugar in the diet may help prevent yeast infections. Other dietary factors contributing to candidiasis may include high amounts of milk, dairy products, and foods with high concentrations of yeast (cheese, peanuts, alcohol). The "candida diet" allows no alcohol, no simple sugars, no yeast, and very limited amounts of refined foods. Alternative therapies use natural antifungals or probiotics ("friendly" bacteria) as well as immune-strengthening therapies to improve the body's ability to keep candida, a naturally occurring micro-organism, in check. There is conflicting evidence as to whether eating yogurt with live probiotic cultures every day can help prevent yeast infections, but it certainly does no harm.

• Lactobacillus acidophilus (1 - 10 billion live organisms per day) to help restore normal balance of bacteria in the bowel and mucous membranes. Other probiotics include bifidobacteria (10 billion colony-forming units per day).
• Vitamin C (500 - 1,000 mg per day), vitamin E (200 - 400 IU per day), and selenium (200 mcg per day) are anti-inflammatory and support immune function.
• Essential fatty acids: anti-inflammatory, a mix of omega-6 (evening primrose) and omega-3 (flaxseed) may be best (2 tbs. oil per day or 1,000 - 1,500 mg twice a day). Reduce animal fats in your diet and increase fish and nuts.
• B-complex: B1 (50 - 100 mg), B2 (50 mg), B3 (25 mg), B5 (100 mg), B6 (50 - 100 mg), B12 (100 - 1,000 mcg), folate (400 mcg per day).
• Calcium (1,000 - 1,500 mg per day) to correct deficiency often found in people with yeast infections, and magnesium (750 - 1,000 mg per day) to balance calcium intake.
• Caprylic acid (1 g with meals) is an antifungal fatty acid.
• Zinc (15 mg per day) appears to increase resistance in animal studies.
• Avoid simple carbohydrates, including fruit juice, yeast, and fermented foods. Limit fruit to one serving per day. Increase garlic (fungicidal), nuts (essential fatty acids), whole grains (B vitamins), oregano, cinnamon, sage, and cloves (antifungal spices).
• Avoid overuse of antibiotics that kill off the friendly bacteria that normally keep candida in check. Talk to your doctor about the proper use of antibiotic medications, when they are necessary, and when it may be safe to try alternatives first.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Pau d'arco bark ( Tabebuia avellanedae ): antifungal, best used as a tea (2 tbs. boiled in 1 quart of water; 3 - 6 cups per day), or use the cooled tea as a vaginal douche.
• Garlic ( Allium sativum) has antifungal properties. Take the equivalent of one clove per day (or one tablet that equals 4,000 - 5,000 mcg of allicin).
• The juice of the herb echinacea ( Echinacea purpurea ) has been shown to lower the recurrence of vaginal yeast infections. Take 2 - 4 ml per day .
• Goldenseal (Hydrastis canadensis), Oregon grape root (Mahonia nervosa), and barberry (Berberis vulgaris) contain berberine, a digestive and immune stimulant. Take 2 - 4 grams of the dried bark or 250 - 450 mg of the herbal extract three times per day. Chamomile (Matricaria recutita) and licorice (Glycyrrhiza glabra) are anti-inflammatory. Use a tea or tincture (1 cup tea three times per day or 30 - 60 drops tincture three times per day) for 6 weeks. Do not take licorice if you have high blood pressure or heart failure.
• Topical treatments include tea tree oil (Melaleuca alternifolia) or lavender essential oil (Lavandula species ) two to three times a day. Apply full strength to skin infections (discontinue if skin irritation develops). You can apply marigold (Calendula officinalis) three to five times per day in a salve for rashes. These treatments are for external use only.
• Fireweed (Epilobium parviflorum): take as a tea for oral, vaginal, and intestinal candidiasis.

Homeopathy

Some of the most common remedies used for candidiasis are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better.

• Borax for bleeding oral mucosa, especially with diarrhea
• Belladonna for bright red, inflamed skin that is not raw or oozing, but is painful, especially with irritability
• Chamomilla for "diaper" rash, especially with irritability
• Arsenicum album for burning, itching rashes, especially with anxiety
• Graphites for thick, cracked skin (corners of mouth or heels)
• Kreosotum for leukorrhea that causes itching and swelling

Acupuncture

Acupuncture may help stimulate the immune system, digestion, and relieve stress.

Following Up

You can prevent another yeast infection by taking lactobacillus acidophilus when you take antibiotics, wearing cotton or silk underwear, maintaining good hygiene, and staying at the proper weight. Women should avoid douches (except when medically necessary), vaginal deodorants, and bubble baths.

Special Considerations

Be sure to tell your health care provider if you are pregnant.

Supporting Research

Arora DS, Kaur J. Anti-microbial activity of spices. Int J Antimicrob Agents . 1999;12:257-62.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:263, 417.

Berkow R, Fletcher AJ, eds. The Merck Manual of Diagnosis and Therapy. Rahway, NJ: Merck & Company Inc; 1992.

Bhakat MP. Therapeutic trial of Berberine sulphate in non-specific gastroenteritis. Indian Med J. 1974;68:19-23.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Boston, Mass: Integrative Medicine Communications; 1998:463.

Hronek M, Vachtlova D, Kudlackova Z, Jilek P. Antifungal effect in selected natural compounds and probiotics and their possible use in prophylaxis of vulvovaginitis. Ceska Gynekol . 2005 Sep;70(5):395-9.

Coeugniet E, Kühnast R. Recurrent candidiasis: Adjutant immunotherapy with different formulations of Echinacin®. Therapiewoche . 1986;36:3352-3358.

Conn RB, Borer WZ, Snyder JW, eds. Current Diagnosis 9. Philadelphia, Pa: WB Saunders Co; 1996.

Gruenwald J, Brendler T, Jaenicke C, et al., eds. PDR for Herbal Medicines. Montvale, NJ: Medical Economics Co; 1998:728.

Henry JR. Clinical Diagnosis and Management by Laboratory Methods. Philadelphia, Pa: WB Saunders Co; 1996.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:68, 115-117, 171-172, 210.

Tierney LM Jr, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis and Treatment 1999. 38th ed. Stamford, Conn: Appleton & Lange; 1999.

• Review Date: 6/15/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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