Yeast infections are considered recurrent or chronic when at least four discrete episodes occur in one year or at least three episodes occur in one year and are not related to antibiotic therapy.¹ Chronic or recurrent yeast infections can occur if conditions in the body are favorable for yeast overgrowth such as a disruption of the vaginal pH and flora.
If something disrupts the balance of your vagina’s pH, yeast can get out of control and cause an infection.
In the vagina, chronic yeast infections can happen when there’s an imbalance or variation in vaginal bacteria which normally help keep Candida from overgrowing. An imbalance or disruption can happen if too much bacteria are removed via antibiotics or can be triggered by anything that may affect the natural pH of the vagina such as douching or menstruation.
In most women, there is no underlying health problem that leads to a yeast infection, however, there are several risk factors that may increase the chances of developing an infection.
Risk Factors for Recurrent Vulvovaginal Infections
There are a few things that can disrupt that balance and cause a yeast infection, including:⁵⁺⁷⁻¹⁵
- Antibiotics: Yeast infections are common in women who take antibiotics. Broad-spectrum antibiotics, which kill a range of bacteria, also kill healthy bacteria in your vagina, leading to overgrowth of yeast. In fact, one-quarter to one-third of women are prone to vulvovaginal candidiasis during or after taking broad spectrum antibiotics.
- Hormonal contraceptives: (e.g., birth control pills, patch, and vaginal ring) – The risk of yeast infections may be higher in women who use birth control methods that contain the hormone estrogen. Estrogen can promote higher levels of glycogen (a stored form of glucose, also known as sugar) in the vagina which acts as a food source for yeast.
- Contraceptive devices: Vaginal sponges, diaphragms, and intrauterine devices (IUDs) may increase the risk of yeast infections. Spermicides do not usually cause yeast infections, although they can cause vaginal or vulvar irritation in some women.
- Weakened immune system: Yeast infections are more common in people who have a weakened immune system due to HIV or use of certain medications (steroids, chemotherapy, post-organ transplant medications).
- Pregnancy: Vaginal discharge becomes more noticeable during pregnancy, although yeast infection is not always the cause.
- Diabetes: Women with poorly controlled blood sugar are at greater risk of yeast infections than women with well-controlled blood sugar.
- Sexual activity: While vaginal yeast infections are not a sexually transmitted infection, they are however, more common in women who are sexually active.
- Scented products: In some cases, a new soap or laundry detergent with fragrance can set you up for a yeast infection by disrupting your natural pH balance.
- Hanging around in damp clothes: Wearing sweaty gym clothes or a wet bathing suit for too long can also contribute to yeast infections. Yeast loves warm, moist environments, and your workout gear or a wet bathing suit can trap heat and sweat, allowing yeast to flourish.
- Douching: Douching can promote pH disruption and upset the balance of bacteria in your vagina, allowing yeast infection fungus to take over. It’s best to skip douching altogether.
Studies suggest that, in most women, recurrent infections are due to relapse from a persistent vaginal reservoir of organisms or endogenous reinfection with the identical strain of susceptible C. albicans 2,3. In other cases, recurrent infections may be caused by the resistance of non– C. albicans species to antifungal agents. Although Candida albicans is the pathogen identified in most patients with vulvovaginal candidiasis, other possible pathogens include Candida tropicalis and Candida glabrata.
Chronic or Recurrent infections may be caused by the resistance of non– C. albicans species that cannot be treated with traditional imidazole antifungal medications.
Did you know?
Exposure to antibiotics may negatively impact the vaginal environment:
- Widespread use of antibiotics may eradicate lactobacillus (friendly bacteria) in the GI tract & vagina, changing vaginal pH.
- The resulting environment favors recurrence, as Candida proliferates and cause infections, primarily by C. albicans.
- Candida become pathogenic as the hyphae of their mycelial form attach to the lining of the vaginal wall, causing infection.
- Continued antibiotic use perpetuates recurrent infection in susceptible women.
- Sobel JD. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 1985; 152:924.
- Vazquez JA, Sobel JD, Demitriou R, et al. Karyotyping of Candida albicans isolates obtained longitudinally in women with recurrent vulvovaginal candidiasis. J Infect Dis 1994; 170:1566. 20.
- Lockhart SR, Reed BD, Pierson CL, Soll DR. Most frequent scenario for recurrent Candida vaginitis is strain maintenance with “substrain shuffling”: demonstration by sequential DNA fingerprinting with probes Ca3, C1, and CARE2. J Clin Microbiol 1996; 34:767.
- Spinillo A, Capuzzo E, Gulminetti R, Marone P, Colonna L, Piazza G. Prevalence of and risk factors for fungal vaginitis caused by non-albicans species. Am J Obstet Gynecol. 1997;176:138–41.
- Horowitz BJ. Mycotic vulvovaginitis: a broad overview. Am J Obstet Gynecol. 1991;165:1188–92.
- Fong IW, Bannatyne RM, Wong P. Lack of in vitro resistance of Candida albicans to ketoconazole, itraconazole and clotrimazole in women treated for recurrent vaginal candidiasis. Genitourin Med. 1993;69:44–6.
- O’Connor MI, Sobel JD. Epidemiology of recurrent vulvovaginal candidiasis: identification and strain differentiation of Candida albicans. J Infect Dis. 1986;154:358–63.
- Reed B. Risk factors for Candida vulvovaginitis. Obstet Gynecol Surv. 1992;47:551–60.
- Spinillo A, Capuzzo E, Acciano S, De Santolo A, Zara F. Effect of antibiotic use on the prevalence of symptomatic vulvovaginal candidiasis. Am J Obstet Gynecol. 1999;180:14–7.
- Bohannon NJ. Treatment of vulvovaginal candidiasis in patients with diabetes. Diabetes Care. 1998;21:451–6.
- Sobel JD, Faro S, Force RW, Foxman B, Ledger WJ, Nyirjesy PR, et al. Vulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations. Am J Obstet Gynecol. 1998;178:203–11.
- Sobel JD. Pathogenesis and treatment of recurrent vulvovaginal candidiasis. Clin Infect Dis. 1992;14(suppl 1):S148–53.
- Hilton E, Chandrasekaran V, Rindos P, Isenberg HD. Association of recurrent candidal vaginitis with inheritance of Lewis blood group antigens. J Infect Dis. 1995;172:1616–9.
- Spinillo A, Pizzoli G, Colonna L, Nicola S, De Seta F, Guaschino S. Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis. Obstet Gynecol. 1993;81:721–7.
- Fong IW. The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin Med. 1992;68:174–6.
- Horowitz BJ, Giaquinta D, Ito S. Evolving pathogens in vulvovaginal candidiasis: implications for patient care. J Clin Pharmacol. 1992;32:248–55.
- Fong IW. The value of prophylactic (monthly) clotrimazole versus empiric self-treatment in recurrent vaginal candidiasis. Genitourin Med. 1994;70:124–6.
Recurrent Yeast Infections: Recurrent yeast infections, also called Recurrent Vulvovaginal candidiasis (RVVC), can be super frustrating. Click here to learn more about recurrent yeast infections and what you can do about them.
Antifungal Resistance: The growing concern over the risk of resistance is the primary reasons most healthcare practitioners are now turning towards new approaches to prevent recurrent yeast infections. Click here to learn more about using antibiotics wisely!