How do you treat recurrent yeast infection? The patient has normal blood sugar and responds to fluconazole (Diflucan), butoconazole (Gynazole), or terconazole (Terazol), but the symptoms return. I would like a standard of care that addresses treatment using longer therapy and maintenance for prevention after symptoms are resolved.—NANCY J. YOUNG, MSN, Greensboro, N.C.
The CDC Web site lists treatment options for recurrent vulvovaginal candidiasis. A general vaginal culture should be done to confirm the diagnosis and determine whether an atypical yeast species is responsible. Ensuring that the right species is treated can help alleviate each clinical episode and prevent recurrences. Some experts recommend a longer duration of initial therapy or repeat treatments (e.g., seven to 14 days of topical therapy or three doses of fluconazole every third day rather than single-dose therapy) to ensure full remission. Maintenance regimens are only recommended once expanded therapy has failed. Maintenance regimens, also available on the CDC Web site, include weekly oral fluconazole for six months or topical clotrimazole once or twice per week. Beyond checking blood sugar, history-taking and relevant labs should also be used to rule out other immunosuppressive conditions like HIV. Also check that your patient is not using vaginal products or other agents that can cause or exacerbate candidiasis.—Lisa Stern, APRN (143-4)