Aug. 25, 2005 -- Most women experience vaginal yeast infections at some point in their lives, but an unfortunate few get them again and again. Preventing repeated infections has been an elusive goal for the roughly 5% of women who have recurrent vaginal yeast infections, but new research should change that.
The antifungal drug Diflucan, taken just once a week, was found to reduce the frequency of infections by more than 90% in a six-month study involving nearly 400 women with a history of recurrent candida vaginal infections.
Researcher Jack D. Sobel, MD, tells WebMD that the drug represents the first safe and highly effective preventive therapy for women with recurrent vaginal yeast infections, defined as those occurring four or more times a year.
"The responses we saw in this study were remarkable," he says. "For many patients, this treatment gave them back a normal life."
A Cure for Some?
The women treated with Diflucan initially took three 150-milligram oral doses of the drug at 72-hour intervals, followed by a weekly 150-milligram dose taken for six months.
By the end of the six-month treatment period just 8% of the women on Diflucan had experienced recurrences, compared with 64% of women in the study given a placebo pill. Six months after treatment ended, however, 57% of the women treated with Diflucan had experienced recurrences.
The study was funded by Diflucan manufacturer Pfizer Pharmaceutical, a WebMD sponsor. It is published in the Aug. 26 issue of the New England Journal of Medicine.
Roughly 43% of the Diflucan-treated women had no vaginal infections in the six months after treatment ended, representing a "cure," Sobel says, because treatment appeared to break the pattern of frequent recurrence.
In an editorial accompanying the study, vaginitis researcher David A. Eschenbach, MD, was more restrained. The University of Washington professor of obstetrics and gynecology called the regimen "an effective treatment strategy for the time being," but added that the high rate of recurrence among patients who stopped the drug needs further study.
While the study only included women treated with the antifungal drug for six months, Sobel says he has patients who have taken the drug weekly for almost a decade with no evidence of side effects.
"Patients don't want to stop taking this treatment," he says. "A significant number of my patients have taken it for more than two or three years, and I have some women who have been on it for as long as eight and nine years."
Diagnosis a Problem
Eschenbach writes that the frequent misdiagnosis of vaginal yeast infections and other causes of vaginitis remains a significant obstacle to effective treatment.
"Successful treatment is often delayed because the causes of [vaginitis], including candidiasis, are commonly misdiagnosed both by patients and physicians -- mainly because the symptoms and signs may be nonspecific, but also because of the lack of inexpensive and accurate diagnostic tests and because of suboptimal medical training. "
Sobel says as many as 80% of the patients he sees who believe they have recurrent vaginal yeast infections are mistaken. For example, women with vulvodynia, which is a poorly understood condition which causes pain and inflammation of the female genitalia, can be misdiagnosed as having vaginitis. Approximately 30% of women without symptoms have candida yeast in the vagina.
"They definitely have the symptoms, and many are told this is what they have by their doctor," he says. "But unless a vaginal yeast culture is performed the doctor is only guessing. A woman who thinks she has recurrent yeast infections has to find a competent doctor and demand this test."
SOURCES: Sobel, J. New England Journal of Medicine, Aug. 26, 2004; vol. 351: pp 876-883. Jack D. Sobel, MD, division of infectious diseases, Wayne State University School of Medicine, Detroit. David Eschenbach, MD, professor of obstetrics and gynecology, University of Washington Medical Center, Seattle.