C. glabrata in­fec­tion con­cerns woman

Connecticut Post - - ADVICE/GAMES - Keith Roach, M.D.

Dear Dr. Roach: I am a 66-year-old fe­male in good health. In May 2017, my Pap smear showed that I had an in­fec­tion of Can­dida glabrata and an itchy fun­gal in­fec­tion in my rear-end area.

My fam­ily doc­tor pre­scribed nys­tatin and tri­am­ci­nolone cream to treat the fun­gal in­fec­tion, which seemed to help, and a six-day Di­flu­can treat­ment for the Can­dida.

Once again, my re­cent Pap shows that I still have the Can­dida glabrata in­fec­tion.

My doc­tor re­ferred me to an in­fec­tion spe­cial­ist. I will sched­ule that soon. There is a slight burn­ing in my pri­vate parts.

How con­cerned should I be about this in­fec­tion? What med­i­ca­tion will treat it? I am very con­cerned.


An­swer: Fungi are an en­tire king­dom of life. In medicine, we are mostly con­cerned about yeasts, such as Can­dida, and molds, such as Aspergillus. So I think you are talk­ing just about one fun­gal in­fec­tion, the yeast Can­dida glabrata, which is re­ferred to more com­monly as “a yeast in­fec­tion.” C. glabrata is re­lated to Can­dida al­bi­cans, the more com­mon cause of yeast in­fec­tion, which can af­fect the mouth and throat, but also can cause symp­toms in a woman’s vulva and vagina, as well as the anus and rec­tum of both men and women.

C. glabrata is more re­sis­tant to an­ti­fun­gal drugs, es­pe­cially flu­cona­zole (Di­flu­can), than C. al­bi­cans.

So, if you had per­sis­tent symp­toms, you might be treated with higher doses of flu­cona­zole, a re­lated drug like voricona­zole or posacona­zole, or with a cream prepa­ra­tion of a drug with bet­ter ac­tiv­ity against C. glabrata, such as mi­cona­zole. The in­fec­tious dis­ease spe­cial­ist cer­tainly will have ex­per­tise in deal­ing with this.

It’s crit­i­cal to re­mem­ber, though, that just hav­ing Can­dida (of what­ever species) on a Pap smear does not mean there is an in­fec­tion need­ing to be treated. Most women do have some yeast as part of the nor­mal mi­crobes that live in and around the per­ineum (the gen­eral term for “pri­vate parts”).

It’s the symp­toms that jus­tify treat­ment.

Read­ers may email ques­tions to: ToYourGoodHealth@med .cor­nell.edu or mail ques­tions to 628 Vir­ginia Dr., Or­lando, FL 32803.

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