DEAR DR. GOTT: I am a 70-year-old active woman who has had a yeast infection for almost five years. I have gone to several doctors and have been given prescriptions for all of the usual medicines for yeast infections, the latest being Premarin vaginal cream plus clobetasol propionate cream. All of these prescriptions have worked, but the infection always comes back within two months. The last time the infection was almost to the staph stage.
After my last infection, a biopsy was done. The report said: “Vulvar Biopsy: Ulceration with very severe active chronic inflammation and numerous plasma cells. A serology for spirochetes was negative.” The microscopic description said: “The skin surface is covered by squamous epithelium which is moderately to extensively eroded. There are superficially dilated capillaries and there is a dense infiltration of lymphocytes and plasma cells in the upper dermis. Warthin-Starry stain is negative with appropriately reacting controls. Immunostain for AE1/AE3 is negative for epithelial component. Positive and negative controls worked as expected.”
My concern is that the Premarin cream is now making my ankles swell, and my blood pressure has gone up. (It is usually normal.) Also, when I call my OB/Gyn, I am no longer asked to come; they simply call in a prescription. I am never told to return for a follow-up and feel that this is because I am on Medicare. So far, this has happened with three separate gynecologists.
Do you have any advice or help to offer me?
DEAR READER: Let’s start with the biopsy report. First, ulceration is easy to understand. This simply means that you have a sore. Whether it was caused by scratching or something else is unclear. Inflammation means swelling. Again, this could be caused by scratching or the infection itself.
The identification of numerous plasma cells is more telling. These cells are a type of short-lived antibody-producing leukocyte (a type of white blood cell) that binds with a foreign substance (or what the body perceives to be a foreign substance) and then begins to neutralize or destroy it. Lymphocytes are another type of leukocyte and determine the specificity of the immune reaction to foreign substances and infectious agents.
All of this indicates that your body is fighting off an infection of some sort, is incorrectly attacking normal cells, or is overreacting to a substance you have come into contact with, such as perfumed feminine-hygiene products.
Now, on to what is causing your so-called yeast infection. First, you do not say what symptoms you are experiencing, so I will first review them. These can range from mild to severe and include redness and swelling of the vulva; itching, irritation, pain and/or soreness of the vulva and vagina; a thick, white, odor-free vaginal discharge similar in appearance to cottage cheese; and a burning sensation.
Yeasts are typically present within a normal vagina and in most instances do not present problems. For several reasons, yeasts can multiply and cause symptoms of an infection. In most cases, Candida albicans is the culprit. Thankfully, this type of yeast can be treated easily.
People who have never had a yeast infection before, have more than four a year, or fail to improve with treatment may require extensive testing, including cultures of any discharge or vaginal secretions. Long-term or multidose oral medications and maintenance regimens may be appropriate.
If you truly have a yeast infection, it is either not being treated properly and eradicated completely or it is the result of an underlying condition, such as long-term antibiotic use, uncontrolled diabetes or something else. Return to your gynecologist and demand answers or get a fourth opinion.
