Infection may need focused treatment

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, and a sixday Diflucan treatment for the Candida. Once again, my recent Pap shows that I still have the Candida glabrata infection.

How concerned should I be about this infection? Can it spread to my bloodstream? Will it affect any dental procedures, such as implants? — E.B.

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 about one fungal infection, the yeast Candida glabrata, more commonly known as “a yeast infection.” C. glabrata is related to Candida albicans, the more common cause of yeast infection.

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. It’s the symptoms that justify treatment.

In women without serious disease of the immune system, it is quite rare to develop invasive disease from Candida species, i.e., one that spreads to the bloodstream or would affect dental implants.