Hello Paul and Kitty,

I have a question regarding fluconazole as a treatment for vaginal
yeast infection.

I had my yearly "well woman exam" today and the nurse practitioner
said I had a yeast infection. I was not surprised since I have had
a history of recurring yeast infections in the past. She prescribed
a one tablet, 150 mg dose of Diflucan (fluconazole). She also
recommended that I purchase an acidophilus supplement to prevent a
reoccurrence.

(Quick note, I originally made this appointment to have 3 lumps
checked inside the vaginal canal. The nurse practitioner determined
these to be blocked glands which she suggested could be explained by
the presence of a yeast infection)

I went home and performed a (superficial) search on Google for
Diflucan; I did not find much except that common side effects
include abdominal pain, diarrhea, headache, and nausea. I then
decided to do a search on lef.org for "yeast infection" and found
the protocols for fungal infection, which described methods for
treating yeast overgrowth.

I hesitate taking the fluconazole since my symptoms are mild. My
inclination is to simply follow the LEF protocols. However, I want
to be rid of the yeast for good.

Are you familiar with fluconazole and its effects? Do you have any
recommendations?

Thanks,
Lindsey Sherman

[If I understand what you wrote above ("She prescribed a one tablet, 150 mg dose
of Diflucan (fluconazole). She also recommended that I purchase an acidophilus
supplement to prevent a reoccurrence."), then if you followed her advice you
would be taking 150 mg of fluconazole only *once* followed by acidophilus on
some periodic basis.

Doing research on Candida online was a good idea. The LEF Protocols are a good
source of information - they are generally written well, covering both current
mainstream medicine and complementary health measures for a particular concern
and are up dated reasonably often, with lists of peer-reviewed references. The
sources of prescription medication information are also considerable in their
depth of information - action and side effects being of most interest. There is
no reason why a person with a computer and Internet access can not be reasonably
well informed about a health condition s/he is trying to avoid or has found to
actually be present.

Yeast infections, typically vaginal in women during their reproductive years are
not uncommon. Most women have an occurrence during their life, which does not
mean that it should be taken lightly. It is possible that the higher amount of
sugar in the average diet in North America (and much of Europe) in the past 50
years has increased the incidence for yeast infections on the whole.

Getting "rid of the yeast infection for good" of course is the reasonable goal.
The lifestyle recommendations in the LEF Candida protocol
(http://www.lef.org/protocols/infections/fungal_infections_candida_01.htm ) are
worthwhile and ones I would suggest especially for women (and I most often
follow myself). If I were not making use of these lifestyle practices and were
diagnosed with a vaginal yeast infection, I would immediately put them all into
practice. In addition in that same situation, I would supplement my diet with
probiotics and fructooligosacharrides. With Nancy's Yogurt available to you in
the Phoenix area, you have a good tasting source of L. acidophilus and B.
bifudum (and L.rhamnosus which I seek for urinary tract protection). That might
be sufficient to show elimination of minor symptoms in 2 weeks and if not then
I'd add garlic (a clove of fresh daily as part of diet or a supplement). (Use of
boric acid vaginal suppositories have been shown in studies to be of value with
strains of Candida, but other than albicans.) If however, mild symptoms didn't
disappear in another 2 weeks or worsened, I'd make use of the fluconazole while
maintaining all the other lifestyle and dietary/supplement changes. In that
case, combating the Candida infection may require a "jump-start". A single dose
of fluconazole is a common prescription for it's convenience and efficacy but
the manufacturer-reported 26% incidence of side effects may be worth avoiding,
especially if the symptoms are mild enough to tolerate while trying other
methods first.

Once the infection is gone - and you may want to confirm this with a microscopic
exam of a smear taken from the vaginal mucosa - maintaining an eating practice
and lifestyle that promotes a balance of beneficial bacteria is a must to
prevent susceptible areas from being overwhelmed by Candida.

There are several abstracts available on PubMed of papers on vaginal Candida.
This full paper from American Family Physician in June 2000 elaborates on many
of the points covered in the LEF protocol and mentions others not addressed
there - http://www.aafp.org/afp/20000601/3306.html

After I'd written the above, I did a bit more investigation and found a recent
study that compared butoconazole nitrate 2% site release vaginal cream
(Gynazole-1) and fluconazole 150 mg tablets (Diflucan) in the time to relief of
symptoms in patients with vulvovaginal candidiasis. (PMID: 16338779)
"CONCLUSIONS: Single-dose butoconazole nitrate 2% Site Release vaginal cream
provides statistically significant improvement in time to first relief of
symptoms in the treatment of VVC compared to fluconazole. There is no difference
between these two treatments with respect to total relief of symptoms or
reinfection rate. Although there was no significant difference in the incidence
of adverse events judged by the investigator to be treatment-related,
butoconazole treatment did result in fewer patients experiencing adverse events
than fluconazole." Having read this, I'm surprised that the NP did not offer you
a prescription for the single-dose butoconazole nitrate 2% Site Release vaginal
cream since its absence of *systemic* side effects is not an insignificant
factor. You could contact her for such a prescription now or if you find the
other measures do not relieve your symptoms.

I hope this has helped, Lindsey. Feel free to let us know how the situation is
in about a month. **Kitty]