Debate Continues Over the ‘Yeast Connection’ : Medication: Two drugs to fight routine infections have been approved for over-the-counter sale. They once were available only by prescription.

Women who have frequent vaginal yeast infections can now obtain medication without a prescription.

Gyne-Lotrimin can be purchased over the counter since its January approval by the U.S. Food and Drug Administration. Another medication, Monistat, also has been approved and should be available within the next week to 10 days. The federal agency occasionally honors requests from pharmaceutical companies to reclassify drugs if certain safety considerations are met.

Gyne-Lotrimin and Monistat have chemical compounds that differentiate them from other over-the-counter products for yeast infections that contain natural ingredients. These homeopathic products have been available for some time, but women with severe symptoms often required a prescription product.

Now, with Gyne-Lotrimin and Monistat, these women can get treatment without spending time and money on a doctor’s visit.

Each over-the-counter drug costs about $18 for a one-week supply of either suppositories or cream, and the cost will no longer be covered by most insurers.

On the drug labels, the manufacturers say their products should be used only by women who previously have been diagnosed with yeast infections and thus can recognize the symptoms. In releasing the drugs for over-the-counter sale, FDA experts noted that the symptoms are fairly clear: a white, lumpy discharge and itching sensation. The infection is not associated with pain, fever, skin sores or a foul odor.

“It’s a condition that consumers can easily self-diagnose,” says Kristie Egstrand, a product manager at Schering-Plough HealthCare Products, which makes Gyne-Lotrimin. Monistat is produced by Ortho Pharmaceuticals.

In a clinical study to see whether women could make an accurate self-diagnosis, 82% diagnosed their yeast infections, compared to 85% of physicians, Egstrand says.

Further, she says, surveys show that 25% of the time, physicians prescribe yeast medications over the phone, believing that the patients who called in reporting an infection actually had one and didn’t need to be seen in the office.

“If women have to go in and get an exam every time (they have a yeast infection), that’s a real nuisance,” says Dr. Russell Malinak, a professor at Baylor University in Waco, Tex., and a member of the gynecology committee for the American College of Obstetricians and Gynecologists. “The drug (Gyne-Lotrimin) has been around a long time. It has been found to be safe and has few side effects and complications.”

Malinak calls the FDA’s decision “reasonable.” But, like other health experts, he expresses concern that some women will mistake a different problem for a yeast infection.

Using Gyne-Lotrimin or Monistat when a yeast infection isn’t present won’t cause serious side effects, but it may prevent or delay appropriate treatment.

“I think there are going to be some problems,” says Dr. Gerald Bernstein, a professor of obstetrics and gynecology at USC. “When women get symptoms they think (are) a yeast infection, they can really have something else. They associate itching with a yeast infection, and they assume it’s a yeast infection. But a lot of things can mimic a yeast infection.”

Human papilloma virus (a sexually transmitted disease), skin diseases of the vulva and cancer can cause symptoms similar to a yeast infection, Bernstein says.

Using the new over-the-counter medications could mask symptoms of more serious infections. Because of this concern, Malinak advises that women who have multiple sex partners and are at high risk of contracting sexually transmitted diseases see a physician for any vaginal symptoms, even if they have had a yeast infection before.

Some physicians also fear that women might develop yeast infections resistant to the active ingredients in the two over-the-counter products. The Candida albicans fungus most often causes yeast infections, but “there are a lot of different fungal infections that could cause this,” Bernstein says.

Women who use the medications and do not see improvement in a few days should see a doctor, he recommends. Similar cautions have been expressed by the manufacturers.

It is important for women to use the drugs for the full seven-day course of treatment outlined in the instructions. Yeast infection symptoms often disappear in about three days, Schering-Plough’s Egstrand says, but medication should be continued.