So you think you have a yeast infection. What now?

About 75 percent of women will experience the burning, itching, and discomfort associated with a yeast infection at least once in their lives, and nearly half will experience it more than once.

But here's the twist: most people who think they have a yeast infection don't actually have one.

“There are some pretty simple things that can be done that most people don't bother to do, starting with an accurate diagnosis,” says Dr. Paul Nyirjesy, co-director of the Jefferson Vulvovaginal Health Center in Philadelphia. Here's what you need to know.

What is a fungal infection?

The vagina is a delicate ecosystem of microorganisms, including bacteria and yeast, said Dr. Andrew Rubenstein, director of the department of obstetrics and gynecology at NYU Langone Health. When that balance is disrupted, it can set the stage for the growth of yeast – usually a species called Candida albicans, although there are others.

Symptoms include “itching, burning, irritation, swelling and redness, and with these symptoms women would also have painful intercourse,” says Dr. Jack Sobel, former dean of the Wayne State University School of Medicine, whose research focuses on skin infections. female sexual organs.

Women may also notice abnormal discharge, but more often than not that's an indication of another problem, said Dr. Nyirjesy. “Normal discharge fluctuates a lot,” he explained. “And actually, the infection that causes abnormal discharge much more often than yeast infections is bacterial vaginosis, an infection that most women have never heard of.”

What can cause an infection?

A variety of triggers can disrupt the vaginal environment.

Antibiotics are one of the most common, said Dr. Nyirjesy, because they can kill the good bacteria that help control yeast. Diabetes and treatments for diabetes, such as a class of drugs called gliflozines, are too associated with increased sensitivity to fungal infections.

Hormonal fluctuations can stimulate yeast growth, said Dr. Sobel, so some women may be more susceptible to infections if they receive hormone therapy during menopause, and others during certain phases of the menstrual cycle.

Penetrative sex can lead to a yeast infection, even though it is not a sexually transmitted disease, said Dr. Nyirjesy. The reasons for this are not fully understood; It was long thought it might be yeast on the penis, but that's unusual, he said. Another theory is that something in the friction of sex, and the microscopic abrasions it can cause, triggers a yeast colonization, he noted.

It's unclear why some women recover quickly after one infection and others have recurring infections, even after trying to eliminate many of the possible causes, said Dr. Nyirjesy.

Can I diagnose myself?

Self-diagnosis is difficult with fungal infections. Many of the symptoms “are very non-specific,” said Dr. Sobel. For example, bacterial vaginosis or an allergic reaction to a new sanitary pad can cause much the same symptoms as a yeast infection.

In a 2002 study in which Dr. Sobel was co-authorwomen who thought they had a yeast infection and had gone to a drugstore to buy an over-the-counter treatment were tested to see if they actually had one. Only a third of the 95 participants tested positive for a fungal infection.

There are now several startups selling at-home yeast testing kits. But, said Dr. Sobel, none of these have been approved or monitored by the Food and Drug Administration, so it's difficult to measure their accuracy.

If you think you have an infection, it's worth seeing a doctor, who will perform a pelvic exam and a test (or a few tests, the most accurate of which can take up to a week before the results are known) to detect the presence of yeast and rule out other causes of discomfort, said Dr. Nyirjesy.

If you have a recurring infection and have already discussed a treatment plan with your doctor, you probably don't need to get tested every time, said Dr. Nyirjesy.

What treatment options are there?

Antifungal medications usually control a fungal infection.

The over-the-counter option is Monistat, a suppository. The prescription option is a pill called fluconazole, sold as Diflucan. For those fighting a first, non-recurrent infection, Monistat or a two-pill regimen of Diflucan are about as effective and should do the trick, said Dr. Sobel. Patients may prefer the pills because they are more convenient and neater than a suppository. Some research suggests that fluconazole can increase the risk of miscarriageso the Centers for Disease Control and Prevention recommends against its use by pregnant women or women trying to become pregnant.

In 2022, the FDA approved a new antifungal drug called Vivjoa, which is effective in treating recurring infections and, according to Dr. Nyirjesy can even be more effective than Diflucan in those cases. But the approval came with one major caveat: It cannot be given to women of childbearing age. “And who gets recurring fungal infections? They are usually women in their reproductive years,” said Dr. Nyirjesy.

Boric acid, which is available over the counter in suppository form at most drugstores, is also an option. It could be effective especially for women with recurrent infections, if taken daily for up to two weeks. It is also effective against antifungal yeast strains, said Dr. Sobel.

Is there a limit to the amount of antifungal medication you can take?

Not really. Women with recurring yeast infections can take a maintenance dose of Diflucan for months, even years, said Dr. Sobel. “There are women who have been on fluconazole prophylaxis for 20, 30 years or more,” he said. “It's quite safe. It just needs to be monitored.”

Doctors are increasingly concerned about the development of mold-resistant yeast strains, but these are still rare, said Dr. Sobel. “We don't have any new drugs that work against resistant yeasts,” he said. Research shows that this is approximately the case 7 percent of patients have infections that are resistant to antifungal medications.

Can diet tame an infection?

Only in rare circumstances, said Dr. Sobel. For example, some women with diabetes may find that eating too many sugary foods can cause an infection. But there is no concrete evidence that dietary changes can cause or treat a yeast infection in most women.

Women are often told to take probiotics or eat yogurt (or even soak a tampon in yogurt and insert it into the vagina), but those suggestions are not supported by science. “That's all nonsense,” said Dr. Sobel.