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  • Dr. Emma Galloway MD CCFP

What do nuclear power plants, fibreglass manufacturing, and vaginitis guidelines have in common?


SHORT ANSWER MANAGEMENT POP QUIZ:

- List TWO medications used to treat non-Albicans yeast (hint: NOT Fluconazole)

- List TWO medications used to treat recurrent yeast vaginitis

- Fill in the blank: A recurrent yeast vaginitis patient should receive treatment for ____ month(s)

(Answers are in the blog post below.)

Attendees at this year's review course learned that not all that itches is yeast. But what if it is?

Did you know the SOGC released vaginitis guidelines in 2015?

These guidelines specifically cover treatment of recurrent yeast infection.

First, remember to confirm yeast with culture; not all that itches is yeast, and not all yeast is C. albicans! Non-albicans yeast cannot be managed with fluconazole; you must use an alternative such as boric acid or nystatin.

Next, if you have confirmed C. albicans, and the patient is having >4 infections per year, consider long-term suppression. This has two phases: induction and maintenance. In my practice I tend to use either fluconazole or boric acid.

Fluconazole induction is 3 x 150mg doses 72h apart, followed by weekly 150mg dosing for 6 months. Yes, that's right -- 6 months of treatment is necessary to reduce relapse upon stopping treatment!

Boric acid is 300-600mg daily x 14 days (I tend to prescribe 600 myself) then either 5 days at the beginning of each menstrual cycle if clearly menstrually-related, or else twice weekly, again for 6 months.

Boric Acid has a large variety of industrial uses, including use in fireworks, fibreglass, and in nuclear power plants, but is also mentioned in the vaginitis guidelines. Almost every pharmacy will have compounded boric acid; it is over the counter, and you can reassure patients it is safe for intercourse and oral sex!

There you have it -- you now know how to diagnose and manage true recurrent yeast infections. But remember, not everything that itches is yeast!

Reference: http://sogc.org/guidelines/vulvovaginitis-screening-management-trichomoniasis-vulvovaginal-candidiasis-bacterial-vaginosis-replaces-211-august-2008/

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