JUANA SUMMERS, HOST:
If you or someone you love has ever had a yeast infection, you know it can be truly miserable, and patients want relief as quickly as possible. But some doctors warn that over-the-counter topical treatments can cause their own problems. NPR's Selena Simmons-Duffin explains.
SELENA SIMMONS-DUFFIN, BYLINE: On a recent Tuesday, one of Dr. Stephanie Arnold's primary care patients in Richmond, Va., asked for a same-day appointment. After a lot of summer swimming, she had a suspected yeast infection. She'd tried MONISTAT 1, an over-the-counter treatment. But a week later, she was still so uncomfortable she couldn't sleep. When the patient came in, Arnold examined her.
STEPHANIE ARNOLD: OK. All right, I'm going to do a quick little swab so I can look at it under the microscope.
SIMMONS-DUFFIN: In the office lab, Arnold looked at the slide for evidence of yeast or bacteria.
ARNOLD: All right. Here we go.
SIMMONS-DUFFIN: But everything looked fine.
ARNOLD: OK, so...
SIMMONS-DUFFIN: Back in the exam room...
ARNOLD: I think this is chemical irritation, maybe originally from the pool and the bathing suit. And then the MONISTAT itself, I think, probably has made things worse.
SIMMONS-DUFFIN: Dr. Brandye Wilson-Manigat says she's seen this a lot. She's an OB-GYN in the Los Angeles area. She says patients come in thinking the one-day treatment they'd tried didn't work. An exam would show the medication had cleared the yeast infection but then caused its own problems.
BRANDYE WILSON-MANIGAT: I would just explain that it was kind of like a contact dermatitis, where the treatment led to this kind of inflammatory response.
SIMMONS-DUFFIN: When you're at the pharmacy with a yeast infection, looking for relief, there are usually three options - a seven-day version, a three-day version and a one-day version. All use miconazole, an antifungal medication. The most common brand name is MONISTAT. The one-day version of the medicine has 12 times the active ingredient as the seven-day cream. Guidelines from the CDC say any of these work equally well to clear yeast infections, although, quote, "local burning or irritation might occur." Many patients don't report any side effects, but those who do describe them in colorful language. Product reviews and forum posts use words like agony and hot lava. One poster wrote that it burns, quote, "like the fire of a thousand suns." Dr. Wilson-Manigat has seen this enough that she gives her patients a heads-up.
WILSON-MANIGAT: I would usually say, hey; if you're going to use the over-the-counter medication, please don't get the one-day. Use the seven-day or the three-day.
SIMMONS-DUFFIN: Prestige Brands, which distributes MONISTAT, declined to comment for this story. Dr. Jen Gunter, a San Francisco Bay area OB-GYN and author, notes it could be that women who pick a one-day treatment are more inflamed to begin with, or maybe they didn't have a yeast infection in the first place. That's quite common. There is an oral medication to treat yeast infections called fluconazole, or Diflucan. That requires a prescription, which can be a barrier. Dr. Libby Wetterer, a professor of family medicine at the University of Pennsylvania, says the rationale for why the pill needs a prescription is that overuse could lead to drug-resistant microbes. She tries to make getting the oral pill as easy as possible.
LIBBY WETTERER: For patients irritated and they've had a history of yeast infection, I would trust the person and their body and send them that prescription, often without seeing them.
SIMMONS-DUFFIN: Back in Richmond, Dr. Stephanie Arnold counsels her patient who's dealing with the post-treatment irritation.
ARNOLD: So what we're going to do to help everything calm down is I'm going to send you a prescription for a steroid cream.
SIMMONS-DUFFIN: She said the steroids should help. And she also gave a tip. Keep the cream in the refrigerator for a little extra relief. Selena Simmons-Duffin, NPR News.
(SOUNDBITE OF SHYGIRL SONG, "HEAVEN") Transcript provided by NPR, Copyright NPR.
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