Candidiasis

Introduction

Candidiasis is an infection caused by a yeast-like fungus called candida (Candida albicans). It can infect the mouth, vagina, skin, stomach, and urinary tract. About 75% of women will get a vaginal yeast infection during their lifetime, and 90% of all people with HIV/AIDS develop candida infections. Oral infections (called oral thrush) are most common in infants, elderly people, and those with a weakened immune system.

What Causes It?

Normal amounts of candida live in the mouth, stomach, and vagina, and do not cause infections. Candidiasis occurs when there is an overgrowth of candida. Causes may include taking certain drugs (especially antibiotics, corticosteroids, and some birth control pills), pregnancy, being overweight, having a bacterial infection, or several different health conditions (for example, a weakened immune system, diabetes, and psoriasis).

What to Expect at Your Provider's Office

Many women know when they have a vaginal yeast infection, but if you are not sure or if you have never had one before, you should have your doctor make the diagnosis. Your doctor may take samples for testing (for example, a vaginal wet smear) and do other tests (such as a CT scan or test of your stool) if your doctor suspects the infection has spread. Your doctor may prescribe antifungal medication and recommend that you change your diet. These treatments usually cure candidiasis. If you have recurrent bouts of candidiasis, your doctor may test you for an immune deficiency or some other disease.

Treatment Options

Drug Therapies

Many antifungal medications can treat candidiasis. Your doctor will prescribe a drug depending on your condition.

Antifungal medications -- these include oral rinses and tablets, vaginal tablets and suppositories, and creams. For vaginal yeast infections, medications that are available over the counter include creams and suppositories such as miconazole (Monistat), ticonazole (Vagistat), and clotrimazole (Gyne-Lotrimin). Your doctor may prescribe a pill, fluconazole (Diflucan). Side effects vary.

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, or you could become infected with a new strain of candida.

For severe candidiasis that could be life threatening to someone with a comprised immune system, your doctor may prescribe an intravenous (IV) medication, amphotericin B.

Complementary and Alternative Therapies

Some studies suggest that reducing sugar in the diet may help prevent yeast infections. Other foods that some practitioners believe may contribute to candidiasis 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 processed foods. It isn’t clear whether the diet actually eliminates candida or helps people feel better because it is a healthful diet. Alternative therapies use natural antifungals or probiotics ("friendly" bacteria) as well as immune-strengthening therapies to improve the body's ability to keep candida in check. There is conflicting evidence about whether eating yogurt with live probiotic cultures every day can help prevent yeast infections, but it certainly doesn’t hurt.

• Probiotics -- Lactobacillus acidophilus (1 - 10 billion live organisms per day) or bifidobacterium (10 billion colony-forming units per day) to help restore normal balance of bacteria in the bowel and mucous membranes. Taking probiotics or “friendly bacteria” at the same time that you take antibiotics may help prevent a buildup of candida, although the evidence is mixed.
• Vitamin C (500 - 1,000 mg per day), vitamin E (200 - 400 IU per day), and selenium (200 mcg per day) -- help reduce inflammation and keep your immune system strong.
• Essential fatty acids -- help reduce inflammation. A mix of omega-6 (evening primrose) and omega-3 (fish oil) may be best (2 tbs. oil per day or 1,000 - 1,500 mg twice a day). It also helps to reduce animal fats in your diet and increase fish and nuts. Some essential fatty acids can increase the risk of bleeding. If you take blood-thinning medications or have a bleeding disorder, ask your doctor before taking them.
• 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) -- Many people who have recurrent yeast infections don’t get enough calcium in their diet. You also need magnesium (750 - 1,000 mg per day) to balance calcium intake. Talk to your doctor to see if you need a calcium supplement.
• Caprylic acid (1 g with meals) is another type of fatty acid that may have antifungal properties.
• Propolis, a natural substance created by bees from pine resin, has antifungal properties in test tube studies. One study in humans showed that a special propolis preparation got rid of oral thrush in people who had denture stomatitis (mouth sores).
• Adding more garlic (fungicidal), nuts (essential fatty acids), whole grains (B vitamins), oregano, cinnamon, sage, and cloves (antifungal spices) to your diet may help avoid yeast infections.
• 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 antibiotics, when they are needed, and when it may be safe to try alternatives first.

Herbs

The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, herbs should be taken with care, under the supervision of a health care provider.

• Pau d'arco bark (Tabebuia avellanedae) has antifungal properties. Take it 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 help prevent recurrence of vaginal yeast infections. Take 2 - 4 ml per day.
• Tea tree oil (Melaleuca alternifolia) has antifungal properties in test tubes. In one study, it was effective in treating oral thrush when used as a mouthwash. Tea tree oil is toxic if swallowed, and should only be used as a mouthwash under your doctor’s supervision.
• Pomegranate (Punica granatum) gel was shown to be about as effective as miconazole gel in treating oral thrush associated with denture stomatitis (mouth sores) in one scientific study.

Homeopathy

Although few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider remedies, based on their knowledge and experience, for treating candidiasis. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual. Some of the most common remedies used for candidiasis include:

• 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

Following Up

You may help prevent another yeast infection by taking Lactobacillus acidophilus when you take antibiotics, wearing cotton underwear, maintaining good hygiene, and staying at the proper weight. Women should avoid douches (except when medically necessary) and vaginal deodorant.

Signs and Symptoms

Symptoms of candidiasis may include:

• Creamy white patches in the mouth or on the throat (oral thrush)
• Painful cracks at the corners of the mouth (oral thrush)
• 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 white discharge resembling cottage cheese (vaginal yeast infection)

Special Considerations

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

Supporting Research

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

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

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Hatakka K, Ahola AJ, Yli-Knuuttila H, Richardson M, Poussa T, Meurman JH, Korpela R. Probiotics reduce the prevalence of oral candida in the elderly -- a randomized controlled trial. J Dent Res. 2007 Feb;86(2):125-30.

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Hilton E, Isenberg HD, Alperstein P, et al. Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis. Ann Intern Med. 1992;116:353-357.

Jandourek A, Vaishampayan JK, Vazquez JA. Efficacy of melaleuca oral solution for the treatment of fluconazole refractory oral candidiasis in AIDS patients. AIDS. 1998;12:1033-7.

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Pirotta M, Gunn J, Chondros P, et al. Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: a randomised controlled trial. BMJ. 2004;329:548.

Santos VR, Gomes RT, de Mesquita RA, de Moura MD, França EC, de Aguiar EG, Naves MD, Abreu JA, Abreu SR. Efficacy of Brazilian propolis gel for the management of denture stomatitis: a pilot study. Phytother Res. 2008 Nov;22(11):1544-7.

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Alternative Names