Newly Approved Drug Promises Relief for Chronic Yeast Infections

There's nothing worse than that terrible feeling when you know a yeast infection is coming on, especially if it's not the first or even second or third one you've had this year.

Over 75 percent of women in the United States suffer at least one yeast infection in their lifetime. The infection is characterized by itching, discharge, vaginal pain and swelling. More than 6 percent of those women have recurrent yeast infections, researchers have found.

"Chronic" or "recurrent" is defined as more than three infections in one year, according to Betsy Greenleaf, D.O., an OB-GYN specializing in urogynecology in New Jersey, and advisor for pH-D Feminine Health, a hygiene and wellness company.

The Food and Drug Administration (FDA) recently approved a new medication, Vivjoa (generic name oteseconazole), as the first chronic yeast infection treatment option, offering relief to people who just can't get rid of the problem, which doctors blame on the fungus Candida.

But the new medication comes with one big catch: It isn't recommended for women of childbearing age, due to a risk of birth defects if they become pregnant.

Here's how doctors are planning on integrating the medication into their care, and what other options are available for people suffering with this pesky and painful problem.

What exactly is a yeast infection, and what causes it to recur?

All vaginas have some level of yeast, which thrives in warm, dark, environments—Greenleaf calls the vagina the "perfect place for it to grow." She also said yeast is getting "smarter" and becoming more resistant to medications available for treating infections. Hormones, antibiotics and even the food we eat, such as high-sugar diets, can mess with yeast levels, causing an infection.

"If an individual is living a high-stressed life with a diet full of sugars and inflammatory foods, they are more likely to feed the yeast living in the gut, decrease their immune system and healing," she said.

This can be part of the reason people with chronic yeast infections continue to have issues.

How are most yeast infections treated?

Most women with a yeast infection first stop at the drugstore, where they can purchase over-the-counter vaginal cream and suppositories, such as Monistat. But for many with recurrent yeast infections, that isn't enough, and they seek treatment from their general physician or OB-GYN.

"In traditional medicine, antifungal creams have been used to directly treat the vagina for one to seven days, while oral antifungals are typically given one day and then sometimes repeated. In my years of clinical experience, I have seen and treated women with chronic yeast, and these traditional remedies don't work," Greenleaf said.

David Kimble, M.D., a urogynecologist at the Kimble Center for Intimate Cosmetic Surgery in Pasadena, California, has treated patients with recurrent yeast infections successfully with weekly fluconazole (brand name Diflucan) doses for three months. But for some, even that doesn't work.

Greenleaf said the new medication, Vivjoa, will give doctors, especially those who might not be intimately familiar with treating chronic yeast infections, another tool in their toolbox.

Who is a candidate for this new medicine?

Before women get excited about this new option, experts want patients to know that it really benefits only postmenopausal women.

One of the great limitations of Vivjoa is that it's been associated with an increased risk of birth defects for 690 days after use. Since it stays in your system for so long after use, it's been widely disregarded as a treatment option for anyone in reproductive years. Even if you're not planning a pregnancy, people do still inadvertently become pregnant, and Kimble noted there is an accidental pregnancy rate of 1 in 200 after tubal ligations.

This risk has some experts worried about prescribing Vivjoa.

Kimble said he would "cautiously prescribe this to a minor select population" with chronic yeast infections if they haven't responded to "safer" medications such as fluconazole. But he worries that doctors who aren't paying attention to this side effect might prescribe it to someone who can become pregnant.

The risk of birth defects points to an increased chance of eye and organ development issues in fetuses, according to Trisha Shah, M.D., a reproductive endocrinologist at Conceptions Florida.

Greenleaf added that patients typically have the most issues with yeast infections when they are in a low-estrogen hormonal state, such as postmenopausal, on hormonal birth control, pregnant or breastfeeding. However, only postmenopausal women will typically be able to try Vivjoa, given the risks.

What are the pros and cons of Vivjoa?

For people who can actually take Vivjoa, they might be able to take it for fewer weeks or months than other medications, such as Diflucan. They also might have fewer side effects, Greenleaf said.

"This new drug works in a way that does not interfere with other processes in the liver, so one is less likely to have drug-drug interactions or strain on the liver," she said. "The side effect profile looks promising with low risk of side effects, the highest being nausea or upset stomach, which can happen with any medication."

Shah explained how patients would take the new medicine: "Vivjoa is an oral medication and it is administered on day 1 at 600 mg [milligrams], day 2 at 450 mg, and then at 150 mg once a week for 11 weeks starting on day 14. It can also be coadministered with fluconazole, although the dosing of the medication varies in that scenario."

Kimble warned of an additional risk for postmenopausal women: The new drug interacts with Crestor, a common high cholesterol and triglyceride medication.

Medications, both new and old, aren't your only line of defense against yeast infections, especially if you are hoping to prevent them before they occur. Diet, exercise, balancing your vaginal pH and controlling stress can help prevent infections.

Speak to your healthcare provider directly before trying any medications, so they can give you specific advice about your body and your unique, one-of-a-kind vagina.