Preventing yeast infections on new medication
July 28, 2021 1:04 PM   Subscribe

Due to my worsening heart failure (I do not have diabetes) my cardiologist has put me on Farxiga. One of the very common side effects is yeast infection. He said I will likely have chronic yeast infections and UTIs while on it. How can I prevent this?

I have had 2 yeast infections and 2 UTIs (unrelated) in my life, so I don't think I'm prone to them. Apparently the drug causes yeast infections because you are peeing out a ton of sugar/glucose. Is there anti-yeast or anti-bacterial wipe safe to use on/near my vulva/vagina?

For those who want to say "this is an excellent question to ask your doctor," yeah, I did. He said "gynecological issues" were not what he treated. My gyn said he wasn't familiar with the drug, but wiping well was important. Yeah, no duh.

Bonus because I'm curious question: what is the mechanism of action that makes necrotizing fasciitis specifically in the perinal area a possible side effect?
posted by misanthropicsarah to Health & Fitness (18 answers total) 5 users marked this as a favorite
I find that taking acidophilus helps with any yeast infections for me. I like the tablets from Trader Joe's, taking 2-3 of them at a time when I'm feeling one coming on. You can find them in natural stores as well. IANYD, but I'd imagine that taking 1-2 pills daily would be sufficient to keeping some of the flora in check.

Acidophilus is one of the strains found in yogurt, but I've not found that increasing yogurt intake helps much. The pills are a better method. You might find that there are other probiotics that are also helpful. Possibly a combination of them. Essentially, you want to help your good bacteria flourish so they can kill the yeasty baddies.
posted by hydra77 at 1:21 PM on July 28, 2021

To discuss with your doctor: d-mannose; lactoferrin and lactobacilli. Coupla cites:

Urinary tract infections (UTI) are highly frequent in women, with a significant impact on healthcare resources. Although antibiotics still represent the standard treatment to manage recurrent UTI (rUTI), D-mannose, an inert monosaccharide that is metabolized and excreted in urine and acts by inhibiting bacterial adhesion to the urothelium, represents a promising nonantibiotic prevention strategy. [De Nunzio, Cosimo et al. “Role of D-Mannose in the Prevention of Recurrent Uncomplicated Cystitis: State of the Art and Future Perspectives.” Antibiotics (Basel, Switzerland) vol. 10,4 373. 1 Apr. 2021, doi:10.3390/antibiotics10040373]

Warding Off Recurrent Yeast and Bacterial Vaginal Infections: Lactoferrin and Lactobacilli [Superti, Fabiana, and Francesco De Seta. “Warding Off Recurrent Yeast and Bacterial Vaginal Infections: Lactoferrin and Lactobacilli.” Microorganisms vol. 8,1 130. 17 Jan. 2020, doi:10.3390/microorganisms8010130]
posted by Iris Gambol at 1:27 PM on July 28, 2021 [9 favorites]

Check out these supplements:
posted by veery at 1:28 PM on July 28, 2021 [3 favorites]

I had chronic yeast infections for a while (I suspect due to my Mirena IUD). The thing that helped most was making my own suppositories out of Boric acid (I would fill empty pill caps with Boric acid powder and a bit of olive oil). I could always feel one coming on and then would make sure to put in a suppository every night for a few days. Since I started doing that I rarely have infections anymore.

My other advice would be to pay attention to other things that might trigger or worsen your infections. For me, I learned that I should avoid wearing super tight pants and always rinse off immediately after swimming in a chlorinated pool, but YMMV.
posted by stella1 at 1:31 PM on July 28, 2021 [1 favorite]

Re: Fournier’s gangrene (and this particular kind of necrotizing fasciitis), it's so rare that even the FDA says there's not much literature on it, but it's from bacteria getting into the teeny cuts and breaks in the skin. There's a lot that goes on with the skin "down there," both the skin sensitivity and the excretion of glucose, so the more you are peeing and excreting, the more important good hygiene is, but you already know that. There's a bit to read in this FDA piece. But to set your mind at ease, 12 (yes, twelve) people taking SGLT2 inhibitors (of which Farxiga is one) were reported to have it between 2013 and 2018. That's 12 people over five years on ALL the different SGLT2 inhibitors (not even just Farxiga).

As for the yeast infections and UTIs, your OB/GYN should give you a prophylactic prescription for something like oral fluconazole (Diflucan) and not make you wait around for topical meds to work. Historically, I've found that even sympathetic male gynecologists just don't recognize the level of discomfort caused by yeast infections and UTIs to think about prophylactic use. (And since your OB/GYN is also a guy, I'd encourage you to consider talking to an OB/GYN who is a woman. I find they are much more eager to delve into these kinds of issues proactively.)

After all these years, advice on preventing yeast infections and UTIs is still mostly home-grown:

Hydrate. A lot.
Drink cranberry juice.
Acidophilus (pills, even though people always used to advise yogurt, but so much yogurt is high in sugar/carbs that you're fighting an uphill battle)
Empty your bladder frequent (especially after intercourse)
Use proper "wiping" techniques (front-to-back, etc.) and wash your hands before using the facilities as well as after.
Don't wear tight undergarments (or thongs) and make sure the crotch area is "breathable" cotton and not nylon or other man-made fabrics. Similarly, don't wear tight jeans/shorts.
Don't douche; good advice anyway, so you don't upset the balance of healthy bacteria.
Don't use fragranced products "down there."

Skip hot tubs and hot baths
Change feminine protection products frequently (but, like, not toooooo frequently)
posted by The Wrong Kind of Cheese at 1:32 PM on July 28, 2021 [2 favorites]

Cranberry juice was seen as a miracle cure for a while, and then it wasn't, but I feel it helps. You need to find the best quality. Someone here on MetaFilter knows everything about cranberries, maybe they will turn up.
posted by mumimor at 1:34 PM on July 28, 2021 [1 favorite]

I am here to second homemade boric acid vaginal suppositories. Also you can put acidopholus tablets right up there, no problem.
posted by DarlingBri at 1:51 PM on July 28, 2021

Using warm water to rinse your vulva and surrounding areas regularly might be helpful. I was having BV problems and associated possible diabetic sugary sweat issues and I ended up buying a peri bottle. (Mine is the much less obnoxious blue color, thank god.) I totally understand bidet people now. When you get sweaty, or are menstruating heavily, or whatever else, and after you pee, use it, getting in various crevices, pat gently dry, and then if you want to use a hair dryer with a cool setting to get things properly dry. It’s a bit silly standing with your legs spread and a hair dryer aimed at your crotch but it feels nice and totally helped wrangle some of my issues. Obviously you could also take a quick shower after working up a sweat, of course. But since my toilet is right next to my tub faucet, I found I could turn it on, pee, and by that time the water would be warm enough to lean over and fill up the bottle. Rinse off, dry, change underwear, get on with things.
posted by Mizu at 2:03 PM on July 28, 2021 [3 favorites]

From the Mayo Clinic site:

“ Many people drink cranberry juice to prevent UTIs. There's some indication that cranberry products, in either juice or tablet form, may have infection-fighting properties. Researchers continue to study the ability of cranberry juice to prevent UTIs, but results are not conclusive.”

So try it if you like, as long as you don’t have a contraindication. If you do drink cranberry juice, note that “juice cocktail” is a completely different object from “100% cranberry juice”. “Juice cocktail” tends to be high in sugar, and may be mostly grape juice. It’s not that useful, even if it is 100% juice of some kind.

Actual 100% cranberry juice is hard to drink. (The part of me that appreciates the placebo effect almost wonders if that’s part of why it seems to work well for me; tastes like medicine. Mmm!). It is not sweet nor anything like sweet.

If you can’t stomach the juice but want to try cranberries anyhow, there are cranberry pills available (but they do seem to be more expensive than they were a few decades ago). And if you’re not into trying the cranberries, it’s possible you can get similar effects just by upping the acidity of your urine— extra vitamin C does that just like cranberry juice does.

Back when I was getting frequent UTIs (many years ago now), I did get offered a standing antibiotic prescription so I could get started on them without having to come in for a urinalysis; I don’t know what current thinking is on this especially re:antibiotic resistance (the *last* thing you want if you’re going to be more susceptible is to harbor your own colony of resistant bacteria! Ugh!). I didn’t end up using it myself because I was too worried about resistance and made some changes (in my case, getting a Mirena IUD) that made my UTIs much less frequent anyhow.

I also had a standing prescription for a pain killer specifically for UTIs, I think it was phenazopyridine. It can cause your urine to become a dye that stains things, but it does work on the pain pretty well.

Anyhow in my personal experience, I mostly got yeast infections after the antibiotics to treat a particularly bad UTI killed off too many other things. Full fat yogurt eaten daily has kept mine from coming back and did in fact prevent me from getting one at all after my most recent UTI even though I needed two courses of antibiotics to kill it. It sounds like you may have different needs though, if the drug you’ll be taking can cause both UTI and yeast infection susceptibility.

I don’t know how either antibiotics or the pain killer would interact with your other drugs, and it’s a bit concerning that your doctors don’t seem to be thinking about this. Doctors should be able to treat the whole patient (I know that’s an idea that isn’t always reachable, but the “I don’t do gynecology” bullshit seems straight up sexist. Especially given that the percentage of female doctors in GYN is higher than in other specialities; it sounds like this person is saying “I’m not a woman who treats the woman bits!” If so what a douche, see if you can get a better doc). It might be worth finding out if other patients on the same drug you are on get offered medical options to treat the UTIs; is there a forum specific to your condition where you could ask? You might also consider taking up the pharmacist who fills your prescription on their willingness to talk to you about the drug, they would know about drug interactions and common side effects.
posted by nat at 3:01 PM on July 28, 2021

Oh, some more standard prevent the UTI advice, some repeats for what others have already posted; you probably know most of this already but for anyone who doesn’t:

Wipe front to back.
Pee after sex (as soon as possible); consider a shower if you can’t pee.
Consider showering (both partners) before sex.
Any sex toy also gets cleaned before and after too so being careful about sex is important even if it’s sex on your own.
If you do get UTI symptoms, get treatment. Don’t just hope it’ll go away, that’s how you get a kidney infection. (Ick.)
Stay well-hydrated (concentrated urine is even less fun to pee if you have a UTI.)

For yeast infections:
Stay dry or get dry ASAP (so don’t wear your swimsuit for hrs after you swim). I have no idea how people in humid areas manage this though.
Keep sugar away from the area (this one may not be possible for you, but at least don’t add any more).
100% cotton underwear. Synthetics can keep things too moist.
Similarly skirts may be better than pants, and definitely may be better than tight pants.

Last a little philosophy: everybody has got flora and fauna. Both yeast and E. coli (a common UTI bacterium) are natural parts of the biome around our genitalia. The main issue is to keep them in the right places and in balance with each other. You don’t want to kill everything, you want to have a happy healthy personal biome. Unfortunately since people and their biomes vary it might take some time to figure out how to keep yours stable under the perturbation of this new drug— but your doctors should be working with you to help. You have a right to be medically treated as a whole person, including your native biome. Don’t let them brush off this side effect if it turns out to be really problematic for you. (I hope it isn’t!)
posted by nat at 3:24 PM on July 28, 2021 [2 favorites]

Re: boric acid--get the powder prescribed, do not buy it from wherever online. The non-pharmaceutical kind has God knows what in it.
posted by Anonymous at 3:58 PM on July 28, 2021

Nthing D-mannose and keeping phenazopyridine hydrochloride (Azo) on hand for UTI flare-ups. The pain will inevitably set in at 3:00 AM when urgent care is closed.

When I feel a bladder infection coming on, I tend to buy a jar of these things and eat them like candy. This is inconsistent with package labeling. Proceed at your own risk. I DGAF about my own risk, because I’ve had recurrent bladder infections since I was four years old, and I am tired of people asking me if I know not to wipe poop up in there.

If no relief from the stupid gummies, do go to a doctor if you can, and make a fuss. NB: Antibiotics to fight UTIs can often disrupt the vaginal biome and stoke a yeast infection. Get the myconazole on the same trip to the pharmacy. Just assume you’ll need it.
posted by armeowda at 6:28 PM on July 28, 2021

I will say d-mannose was recommended by doctors, and in my own personal experience, before that was a thing, a nurse told me about cranberry pills, and in my experience, taking 2-3 of them the night before I got a twinge of a UTI, and drinking a lot of water, and taking the pills for a few days afterward, did seem to hold them off.

As for yeast infections, that seemed to be a thing that my former husband and I passed between ourselves. I went through the whole insert the prescription thing, and it finally cleared. But after he left, I never got a yeast infection again. The next guy introduced me to UTI's, after he left, I never got one again. The next guy, I never had a problem with, but he had had very few other sexual partners. Go figure. YMMV.
posted by Marie Mon Dieu at 6:54 PM on July 28, 2021 [1 favorite]

Hi, type 1 diabetic here! This type of drug prevents your kidneys from reabsorbing some of the glucose in your system and instead lets you pee it out. That's why there is increased risk of yeast, UTI and other infections - that glucose(sugar) can feed the nasties that cause these infections. However, something to consider - since you don't have diabetes, you won't have excess amounts of sugar spilling into your urine. Sure you'll have some, but definitely not as much as a diabetic would. UTI/yeast infections are not guaranteed. If you do experience it, boric acid capsules work wonders. They sell them at target now specifically for vaginal use.

I also think it's assholish that your doctor would be like "you're going to have serious gyn issues! Deal with it!" You have other medication options if this one gives you serious issues. You do NOT have to live with chronic vaginal issues in order to treat heart failure.
posted by marvelousmellitus at 7:36 PM on July 28, 2021 [11 favorites]

On the sexual partners side of things- vaginas like to be slightly acidic. Semen is basic. So introducing semen can throw things off. (I have confirmed this because I didn't go back on hormonal birth control after kiddo was born, recently began allowing semen again (open to kiddo 2) and hello yeast.

Also in the past treating his bits (just a topical antifungal) worked to help clear things up.
posted by freethefeet at 3:12 AM on July 29, 2021

As mentioned above, I also got recurring yeast infections from my Mirena IUD (I stopped getting my period, and instead got a yeast infection every single month like clockwork! Fun!).

I would honestly not even bother with any of the home remedy stuff and go straight for a recurring fluconazole prescription. My doctor wrote one for me immediately when I described what was going on. That was years ago and I'm still able to fill it if I need it. I don't think there's much worry about taking it regularly (in fact I have a friend who was on very high, regular dose of it for a while because she was having all sort of mystery yeast issues). And it WORKS.

I've also heard good things from friends about boric acid, though I've never tried it myself.

Also, find a female GP if you have to. "I don't treat lady problems, yuck," is such an unhelpful response from your doctor, ugh.
posted by catoclock at 6:27 AM on July 29, 2021 [1 favorite]

Another vote for boric acid capsules, they are in the aisle with the over-the-counter yeast infection/UTI meds at Target. I tried Vitamin C tablets before that, but the boric acid is more effective and less messy. I am also a fan of the pH test strips you can get in the same location (or online), just to have a sense of what is happening before calling the doc.
posted by mcgsa at 8:22 AM on July 29, 2021

IANAD. this was my experience dealing with chronic UTIs and yeast infections for several years. Something to keep in mind is that the antibiotics prescribed for UTIs (esp. if they are recurrent and start requiring stronger antibiotics) really mess with your gut/vaginal flora, which can launch you directly into a yeast infection. When drs prescribe you an antibiotic, ask them to ALSO prescribe you 1-2 dose of diflucan. It will just save you time and energy.

In terms of prevention, you will sort of need to identify your triggers. For yeast infections: Mine included any type of synthetic underwear (make sure things have a 100% cotton crotch, not 95%, 100%). I also would change underwear frequently—after hiking i would put on dry underwear for the drive home, for example. I found that air travel always triggered me, so i started changing undies halfway through a cross-country flight. No scented detergents, soaps, etc, no soap in your labial folds, just water, i found that trimming my pubic hair also helped a bit as well (but this will depend on your body, obviously. I’m a hairy beast!)

For UTIs, peeing after sex is crucial. I also take cranberry PILLS (not just juice), the 24 hours after sex i try to drink water like it’s my job. Literally i pee, then chug an 8oz glass of water, for the entire day. If you pee constantly it’s hard for anything to start growing.

Finally, this particular cycle was most improved when i found a gyno who took my situation seriously and was able to provide some more extra medical interventions. In my case i did estrogen inserts into my vagina for a few weeks and that really helped me reset to baseline. Again, the point is not what my medical intervention was, it’s that i had a good doctor, finally
posted by you'rerightyou'rerightiknowyou'reright at 10:59 AM on July 29, 2021

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