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VAGINAL CANDIDIASIS AND HIV DISEASE
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Document Description
Vaginal candidiasis is a fungal or yeast infection of the
vulva and/or vagina. It causes a smelly, thick, white-
yellow discharge that might be accompanied by itching,
burning and swelling. It can also can make walking,
urinating or sex very painful.
Vaginal candidiasis can be an occasional problem
for even the healthiest woman. However, it’s more
common and severe in women with weakened immune
systems. For many, a repeating or worsening vaginal
yeast infection is the first symptom of HIV infection.
This infection can occur at any CD4+ cell count but is
likely to occur more often when your CD4+ count
falls below 100.
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VAGINAL CANDIDIASIS
AND HIV DISEASE
!
A PUBLICATION FROM
preventing and treating fungal
infections in the vagina
Information,
Inspiration and
Advocacy for People
Living With HIV/AIDS
NOVEMBER 2005
Vaginal candidiasis is a fungal or yeast infection of the
common and severe in women with weakened immune
vulva and/or vagina. It causes a smelly, thick, white-
systems. For many, a repeating or worsening vaginal
yellow discharge that might be accompanied by itching,
yeast infection is the first symptom of HIV infection.
burning and swelling. It can also can make walking,
This infection can occur at any CD4+ cell count but is
urinating or sex very painful.
likely to occur more often when your CD4+ count
Vaginal candidiasis can be an occasional problem
falls below 100.
for even the healthiest woman. However, it’s more
© PROJECT INFORM 205 13TH STREET, SUITE 2001 SAN FRANCISCO, CA 94103-2461 415-558-8669 FAX 415-558-0684 SUPPORT@PROJECTINFORM.ORG WWW.PROJECTINFORM.ORG
cause
antifungal drugs and pregnancy
Vaginal candidiasis is caused by the fungus called Candida.
The US Public Health Service Guidelines for the Preven-
Everyone has small quantities of the fungus in the mouth,
tion of Opportunistic Infections include recommenda-
vagina, digestive tract and skin. In healthy persons,
tions about using antifungal drugs during pregnancy. In
“friendly” bacteria and the immune system prevent the
short, the Guidelines recommend
fungus from causing infection. However, if you have a
that oral azole antifungals—
damaged or weakened immune system, it’s easier for
including fluconazole (Diflucan),
Candida to grow and cause disease.
itraconazole (Sporanox) and
Certain drugs can alter the natural organisms in the
ketoconazole (Nizoral)—
vagina, which can then promote the growth of Candida.
should not be used during
These include the extended use of antibiotics, steroids
pregnancy because they have
and oral contraceptives (birth control) with a high estrogen
caused birth defects in
content. Other factors that may cause candidiasis include
animal studies.
diabetes, pregnancy, using antihistamines (drugs com-
If you are pregnant and
monly used to prevent allergies and rash) and iron, folate,
treating or preventing vaginal
vitamin B12 or zinc deficiency. Factors that may weaken
candidiasis, topical therapies
the immune system—from cancer chemotherapy to stress
are preferable. Moreover, it’s
and depression—can also cause candidiasis. Tight fitting
recommended that oral azole
pants and reactions to chemical ingredients found in soaps
drugs be stopped in women who
and detergents can lead to vaginal candidiasis as well.
become pregnant and that women
taking these drugs use effective birth
diagnosis
control.
Vaginal candidiasis is usually diagnosed by appearance
conclusion
and symptoms. Because symptoms are similar to many
other conditions, like the sexually transmitted infection
Candidiasis is among the most common conditions in
2
trichomonas, your doctor should confirm a diagnosis by
people with HIV. While it’s a relatively common condition
scraping an affected area for examination under a micro-
in general, it’s often the first sign of illness that HIV
??
scope. Other lab tests are usually done if the infection
disease is progressing to a more severe stage, particularly
does not clear up after treatment.
yeast infections that recur or respond less to treatment.
Candidiasis outbreaks can be frequent, cause great dis-
comfort and add to the decline in health seen in AIDS.
?
??? ????
treatment
?
It’s important for you to
?
Topical treatments (active only on the area where applied)
prevent and treat vaginal can-
. ?
are the first choices for yeast infections and these generally
didiasis, like other forms of
work for mild-to-moderate cases. These include vaginal
candidiasis. This will improve
creams, suppositories or tablets. Many are available over
the discomfort created by the
the counter in a drugstore.
infection and reduce further
!
Most topical treatments are put into the vagina once
damage candidiasis may cause
?????? ????
or twice a day for three days or once a day for seven days.
to your immune system.
For more
(See table on page 4 for drug names and doses.) Longer
For information on oral
treatment
courses (7–14 days) may be more effective in HIV-posi-
and systemic candidiasis, read
information, call
?
?
? . ??
tive women.
Project Inform’s publications,
Project Inform’s
Generally, topical treatments do not cause side effects,
Oral Candidiasis and Systemic
????
but in a small number of women they may lead to
toll-free National
Candidiasis, available at
vaginal burning, itching or skin rash. A few women have
HIV/AIDS
1-800-822-7422 or
experienced cramps or headaches. Oil-based vaginal
www.projectinform.org
Treatment
.
? ????
?
creams should be used with caution as they may weaken
Information
latex condoms and diaphragms (see chart, page 4).
Infoline at
???
If topical treatment does not work, or if outbreaks
1-800-822-7422.
?
?
recur often, you may need systemic (throughout the body)
drugs. A single oral dose of fluconazole (Diflucan) is
increasingly used to treat vaginal candidiasis.
TO L L-FREE NAT I O NAL HIV/AIDS TREATMENT INFOLINE 1-800-822-7422 LO C A L AND INTERNATIONAL 415-558-9051 MONDAY–FRIDAY 10–4 PACIFIC TIME
?
preventing vaginal candidiasis
?
???
There are many practical ways to try to prevent vaginal candiaisis (see below). For women with recurrent
?
vaginal candidiasis, a single dose of fluconazole weekly is sometimes used to prevent the infection.
? ????
Caution is recommended when considering this approach since extended use of fluconazole can result
in candidiasis that becomes resistant to treatment.
??
Gentian violet has been used to treat and prevent fungal infections for years. It is available without
??
a prescription, but your doctor may have special instructions for preventing vaginal candidiasis. As a
?
?
prevention strategy, it is applied onto the affected areas with a cotton swab once a week for four weeks,
? . ??
or as instructed by your doctor.
?????? ???
Practical prevention tips
Food as prevention
Treating and preventing
fungal infections naturally
• Avoid douching. Douching
• Decrease or avoid sugars
There’s a strong connection be-
changes the normal acid level of
(corn and maple syrup, glucose,
tween what you eat and the health
?
the vagina and causes inflam-
fructose and sucrose). Sugars
. ?
of your immune system. Never-
mation, both of which may
are food for Candida and help
?
theless, nutritional approaches to
increase the risk of infection.
it grow.
????? ????
prevent and treat conditions like
• Try not to use scented
• Decrease or avoid alcohol.
candidiasis are complicated and
laundry soap, bleach or
Alcohol converts to sugar and
controversial. While there isn’t a
fabric softeners. Chemicals in
helps Candida grow.
magic recipe that prevents or
scented laundry soap can cause
??
• Swallow large amounts of
treats yeast infections in every-
yeast infections. Bleach in your
garlic. (Fresh is considered
one, following some basic guide-
clothes may harm the friendly
best—mince and put into empty
lines may lower the risk of yeast
3
bacteria that stop Candida from
gelatin capsules, up to six cloves
becoming a problem for you.
taking over. Also, fabric softeners
a day.) Garlic is believed to have
Sugar, yeast, dairy, wheat,
stop moisture from escaping,
some natural antifungal pro-
caffeine, nicotine and alcohol
keeping the skin damp and
perties. (NOTE: It is unknown
promote the growth of yeast. Nu-
more likely for yeast to grow.
if large amounts of garlic inter-
tritionists recommend ingesting
• Avoid tight clothes
lothes which
fere with anti-HIV drugs, but
as little as possible of these foods
block air flow.
some evidence exists that it may
and products to decrease the risk
increase the risk of side effects
and/or severity of yeast infections.
• Wear cotton underwear
ear as it
from ritonavir [Norvir].)
Eating larger amounts of foods
lets air in and moisture out.
that may suppress the growth of
• Drink milk or eat yogurt
• Avoid washing the vaginal
yeast, like garlic or milk and
that contains acidophilus bac-
area with deodorant, scented
yogurt that contain acidophilus,
teria. Acidophilus is “friendly”
soaps or bubble baths.
may help prevent yeast infections
bacteria that
• Try a non-soap cleanser
r that
or provide extra treatment for
helps keep
is less likely to irritate the
infections that occur.
your body
vaginal area if yeast infections
in balance.
are a problem for you.
© PROJECT INFORM 205 13TH STREET, SUITE 2001 SAN FRANCISCO, CA 94103-2461 415-558-8669 FAX 415-558-0684 SUPPORT@PROJECTINFORM.ORG WWW.PROJECTINFORM.ORG
treating vaginal candidiasis
DRUG NAME
DOSE
NOTES
TOPICAL THERAPIES
butoconazole 2% cream
5 grams for 3 days
Available over the counter; may weaken
latex condoms and diaphragms
clotrimazole (Lotrimin)
5 grams for 7–14 days
Available over the counter. may weaken
1% cream
latex condoms and diaphragms
clotrimazole (Mycelex)
One 100mg tablet for 7 days
100mg vaginal tablet
or two 100mg tablets for 3 days
clotrimazole (Mycelex)
Single dose
500mg vaginal tablet
miconazole (Monistat)
5 grams for 7 days
Available over the counter; may weaken
2% cream
latex condoms and diaphragms
miconazole (Monistat)
Once a day for 7 days
Available over the counter
100mg vaginal suppository
miconazole (Monistat)
Once a day for 3 days
Available over the counter
200mg vaginal suppository
miconazole (Monistat)
Single dose
1,200mg vaginal suppository
terconazole (Terazol 7)
5 grams for 7 days
May weaken latex condoms and diaphragms
0.4% cream
4
terconazole (Terazol 3)
5 grams for 3 days
May weaken latex condoms and diaphragms
??
0.8% cream
terconazole (Terazol 3)
Once a day for 3 days
80mg vaginal suppository
tioconazole (Vagistat)
A single dose
Available over the counter
?
??? ????
300mg ointment
?
?
. ?
ORAL THERAPIES
fluconazole (Diflucan)
One 150mg dose
Not recommended for pregnant women; some-
times used weekly as a preventive measure
itraconazole (Sporanox)
One 100mg dose
Not recommended for pregnant women; some-
times used weekly as a preventive measure
?????? ????
ketaconazole (Nizoral)
One 200–400mg dose
Not recommended for pregnant women; some-
times used weekly as a preventive measure
?
?
? . ??
OTHER THERAPIES
????
nystatin vaginal tablet
Applied to affected areas
Available over-the-counter. May be useful for
(Mycostatin)
twice a day for three days
recurrent infections (apply every 7 days for 1
month); messy application; can cause vaginal
? ????
swelling; refraining from sex or use of condom
?
recommended
???
?
?
TO L L-FREE NAT I O NAL HIV/AIDS TREATMENT INFOLINE 1-800-822-7422 LO C A L AND INTERNATIONAL 415-558-9051 MONDAY–FRIDAY 10–4 PACIFIC TIME
AND HIV DISEASE
!
A PUBLICATION FROM
preventing and treating fungal
infections in the vagina
Information,
Inspiration and
Advocacy for People
Living With HIV/AIDS
NOVEMBER 2005
Vaginal candidiasis is a fungal or yeast infection of the
common and severe in women with weakened immune
vulva and/or vagina. It causes a smelly, thick, white-
systems. For many, a repeating or worsening vaginal
yellow discharge that might be accompanied by itching,
yeast infection is the first symptom of HIV infection.
burning and swelling. It can also can make walking,
This infection can occur at any CD4+ cell count but is
urinating or sex very painful.
likely to occur more often when your CD4+ count
Vaginal candidiasis can be an occasional problem
falls below 100.
for even the healthiest woman. However, it’s more
© PROJECT INFORM 205 13TH STREET, SUITE 2001 SAN FRANCISCO, CA 94103-2461 415-558-8669 FAX 415-558-0684 SUPPORT@PROJECTINFORM.ORG WWW.PROJECTINFORM.ORG
cause
antifungal drugs and pregnancy
Vaginal candidiasis is caused by the fungus called Candida.
The US Public Health Service Guidelines for the Preven-
Everyone has small quantities of the fungus in the mouth,
tion of Opportunistic Infections include recommenda-
vagina, digestive tract and skin. In healthy persons,
tions about using antifungal drugs during pregnancy. In
“friendly” bacteria and the immune system prevent the
short, the Guidelines recommend
fungus from causing infection. However, if you have a
that oral azole antifungals—
damaged or weakened immune system, it’s easier for
including fluconazole (Diflucan),
Candida to grow and cause disease.
itraconazole (Sporanox) and
Certain drugs can alter the natural organisms in the
ketoconazole (Nizoral)—
vagina, which can then promote the growth of Candida.
should not be used during
These include the extended use of antibiotics, steroids
pregnancy because they have
and oral contraceptives (birth control) with a high estrogen
caused birth defects in
content. Other factors that may cause candidiasis include
animal studies.
diabetes, pregnancy, using antihistamines (drugs com-
If you are pregnant and
monly used to prevent allergies and rash) and iron, folate,
treating or preventing vaginal
vitamin B12 or zinc deficiency. Factors that may weaken
candidiasis, topical therapies
the immune system—from cancer chemotherapy to stress
are preferable. Moreover, it’s
and depression—can also cause candidiasis. Tight fitting
recommended that oral azole
pants and reactions to chemical ingredients found in soaps
drugs be stopped in women who
and detergents can lead to vaginal candidiasis as well.
become pregnant and that women
taking these drugs use effective birth
diagnosis
control.
Vaginal candidiasis is usually diagnosed by appearance
conclusion
and symptoms. Because symptoms are similar to many
other conditions, like the sexually transmitted infection
Candidiasis is among the most common conditions in
2
trichomonas, your doctor should confirm a diagnosis by
people with HIV. While it’s a relatively common condition
scraping an affected area for examination under a micro-
in general, it’s often the first sign of illness that HIV
??
scope. Other lab tests are usually done if the infection
disease is progressing to a more severe stage, particularly
does not clear up after treatment.
yeast infections that recur or respond less to treatment.
Candidiasis outbreaks can be frequent, cause great dis-
comfort and add to the decline in health seen in AIDS.
?
??? ????
treatment
?
It’s important for you to
?
Topical treatments (active only on the area where applied)
prevent and treat vaginal can-
. ?
are the first choices for yeast infections and these generally
didiasis, like other forms of
work for mild-to-moderate cases. These include vaginal
candidiasis. This will improve
creams, suppositories or tablets. Many are available over
the discomfort created by the
the counter in a drugstore.
infection and reduce further
!
Most topical treatments are put into the vagina once
damage candidiasis may cause
?????? ????
or twice a day for three days or once a day for seven days.
to your immune system.
For more
(See table on page 4 for drug names and doses.) Longer
For information on oral
treatment
courses (7–14 days) may be more effective in HIV-posi-
and systemic candidiasis, read
information, call
?
?
? . ??
tive women.
Project Inform’s publications,
Project Inform’s
Generally, topical treatments do not cause side effects,
Oral Candidiasis and Systemic
????
but in a small number of women they may lead to
toll-free National
Candidiasis, available at
vaginal burning, itching or skin rash. A few women have
HIV/AIDS
1-800-822-7422 or
experienced cramps or headaches. Oil-based vaginal
www.projectinform.org
Treatment
.
? ????
?
creams should be used with caution as they may weaken
Information
latex condoms and diaphragms (see chart, page 4).
Infoline at
???
If topical treatment does not work, or if outbreaks
1-800-822-7422.
?
?
recur often, you may need systemic (throughout the body)
drugs. A single oral dose of fluconazole (Diflucan) is
increasingly used to treat vaginal candidiasis.
TO L L-FREE NAT I O NAL HIV/AIDS TREATMENT INFOLINE 1-800-822-7422 LO C A L AND INTERNATIONAL 415-558-9051 MONDAY–FRIDAY 10–4 PACIFIC TIME
?
preventing vaginal candidiasis
?
???
There are many practical ways to try to prevent vaginal candiaisis (see below). For women with recurrent
?
vaginal candidiasis, a single dose of fluconazole weekly is sometimes used to prevent the infection.
? ????
Caution is recommended when considering this approach since extended use of fluconazole can result
in candidiasis that becomes resistant to treatment.
??
Gentian violet has been used to treat and prevent fungal infections for years. It is available without
??
a prescription, but your doctor may have special instructions for preventing vaginal candidiasis. As a
?
?
prevention strategy, it is applied onto the affected areas with a cotton swab once a week for four weeks,
? . ??
or as instructed by your doctor.
?????? ???
Practical prevention tips
Food as prevention
Treating and preventing
fungal infections naturally
• Avoid douching. Douching
• Decrease or avoid sugars
There’s a strong connection be-
changes the normal acid level of
(corn and maple syrup, glucose,
tween what you eat and the health
?
the vagina and causes inflam-
fructose and sucrose). Sugars
. ?
of your immune system. Never-
mation, both of which may
are food for Candida and help
?
theless, nutritional approaches to
increase the risk of infection.
it grow.
????? ????
prevent and treat conditions like
• Try not to use scented
• Decrease or avoid alcohol.
candidiasis are complicated and
laundry soap, bleach or
Alcohol converts to sugar and
controversial. While there isn’t a
fabric softeners. Chemicals in
helps Candida grow.
magic recipe that prevents or
scented laundry soap can cause
??
• Swallow large amounts of
treats yeast infections in every-
yeast infections. Bleach in your
garlic. (Fresh is considered
one, following some basic guide-
clothes may harm the friendly
best—mince and put into empty
lines may lower the risk of yeast
3
bacteria that stop Candida from
gelatin capsules, up to six cloves
becoming a problem for you.
taking over. Also, fabric softeners
a day.) Garlic is believed to have
Sugar, yeast, dairy, wheat,
stop moisture from escaping,
some natural antifungal pro-
caffeine, nicotine and alcohol
keeping the skin damp and
perties. (NOTE: It is unknown
promote the growth of yeast. Nu-
more likely for yeast to grow.
if large amounts of garlic inter-
tritionists recommend ingesting
• Avoid tight clothes
lothes which
fere with anti-HIV drugs, but
as little as possible of these foods
block air flow.
some evidence exists that it may
and products to decrease the risk
increase the risk of side effects
and/or severity of yeast infections.
• Wear cotton underwear
ear as it
from ritonavir [Norvir].)
Eating larger amounts of foods
lets air in and moisture out.
that may suppress the growth of
• Drink milk or eat yogurt
• Avoid washing the vaginal
yeast, like garlic or milk and
that contains acidophilus bac-
area with deodorant, scented
yogurt that contain acidophilus,
teria. Acidophilus is “friendly”
soaps or bubble baths.
may help prevent yeast infections
bacteria that
• Try a non-soap cleanser
r that
or provide extra treatment for
helps keep
is less likely to irritate the
infections that occur.
your body
vaginal area if yeast infections
in balance.
are a problem for you.
© PROJECT INFORM 205 13TH STREET, SUITE 2001 SAN FRANCISCO, CA 94103-2461 415-558-8669 FAX 415-558-0684 SUPPORT@PROJECTINFORM.ORG WWW.PROJECTINFORM.ORG
treating vaginal candidiasis
DRUG NAME
DOSE
NOTES
TOPICAL THERAPIES
butoconazole 2% cream
5 grams for 3 days
Available over the counter; may weaken
latex condoms and diaphragms
clotrimazole (Lotrimin)
5 grams for 7–14 days
Available over the counter. may weaken
1% cream
latex condoms and diaphragms
clotrimazole (Mycelex)
One 100mg tablet for 7 days
100mg vaginal tablet
or two 100mg tablets for 3 days
clotrimazole (Mycelex)
Single dose
500mg vaginal tablet
miconazole (Monistat)
5 grams for 7 days
Available over the counter; may weaken
2% cream
latex condoms and diaphragms
miconazole (Monistat)
Once a day for 7 days
Available over the counter
100mg vaginal suppository
miconazole (Monistat)
Once a day for 3 days
Available over the counter
200mg vaginal suppository
miconazole (Monistat)
Single dose
1,200mg vaginal suppository
terconazole (Terazol 7)
5 grams for 7 days
May weaken latex condoms and diaphragms
0.4% cream
4
terconazole (Terazol 3)
5 grams for 3 days
May weaken latex condoms and diaphragms
??
0.8% cream
terconazole (Terazol 3)
Once a day for 3 days
80mg vaginal suppository
tioconazole (Vagistat)
A single dose
Available over the counter
?
??? ????
300mg ointment
?
?
. ?
ORAL THERAPIES
fluconazole (Diflucan)
One 150mg dose
Not recommended for pregnant women; some-
times used weekly as a preventive measure
itraconazole (Sporanox)
One 100mg dose
Not recommended for pregnant women; some-
times used weekly as a preventive measure
?????? ????
ketaconazole (Nizoral)
One 200–400mg dose
Not recommended for pregnant women; some-
times used weekly as a preventive measure
?
?
? . ??
OTHER THERAPIES
????
nystatin vaginal tablet
Applied to affected areas
Available over-the-counter. May be useful for
(Mycostatin)
twice a day for three days
recurrent infections (apply every 7 days for 1
month); messy application; can cause vaginal
? ????
swelling; refraining from sex or use of condom
?
recommended
???
?
?
TO L L-FREE NAT I O NAL HIV/AIDS TREATMENT INFOLINE 1-800-822-7422 LO C A L AND INTERNATIONAL 415-558-9051 MONDAY–FRIDAY 10–4 PACIFIC TIME
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Women can get it from them as well, and vice-versa.