Why is my yeast infection much worse than usual?

HISTORY
I'm a 47 year old male.  I frequently get yeast infections of my penis and scrotum and sometimes upper thighs.  I got my first one at age 30.

I am a diabetic which makes me prone to yeast infections.  My diabetes is in good control (HgbA1C = 6.0) through diet and exercise.  I have been on the Atkins diet for the last 27 months and have lost 60 pounds (I currently weigh 235 pounds, 5'9").  I am not on any medication except for the yeast treatments described later.  I work out 3 times per week.

I typically get a yeast infection twice a year although it has been over two years since I developed the last one.  They usually cover my penis and scrotum and sometimes a little bit of my upper thighs. When I get them I can usually clear them up with about a week of vaginal yeast cream.  About 1/4th of the time (every two years) I get one that I can't clear up with the creams.  I go to my doctor and he prescribes a couple of Diflucan and that has always cleared it up in the past.

CURRENT SITUATION.
I currently have a yeast infection that I have had for about six or seven weeks.  It is by far the worst one that I've ever had both in the amount of area that it covers and and the duration.  Here is the sequence of events and treatment thus far.

This started at the end of May.  I noticed what I would call my typical yeast infection and applied monistat 7 for several days.  It continued getting worse.  I called my doctor's office and he phoned in a prescription for two diflucan (150 mg) one for right away and one for one week later.  It stopped getting worse for the first four days and then started getting worse again.  I took the second diflucan and the next day I went to see my doctor.  Because of the area it covered (it extended three inches onto my thighs and onto the lower part of my belly) he prescribed 200 Mg Nizoral for 14 days.

After about a week of Nizoral I saw improvement and by the end of the 14 days it was 95% cleared up.  I reported this to my doctor and he phoned in two diflucan (which did not help), one for day one and one for 3 days later.  About 3 days after the second diflucan things started getting worse.  I called my doctor again on Friday but they didn't call anything in until Monday.

By then it was much worse (almost as bad as when I went to the doctor initially).  They called in a Diflucan on Monday which I took.  I called them Tuesday and said I really needed more Nizoral, so on Thursday they called in 14 days of Nizoral.  I am currently on day 9 and things are starting to get better.  I believe that he will prescribe more Nizoral after day 14.  I've also been taking lactobacillus.

I have a few questions:
1)Is there any better course of treatment?
2)Why was this one so much worse than ever before?
3)Should I be worried about some underlying process which made this worse and which may cause me other problems (e.g. my diabetes getting worse, etc.).

[Alan Rockoff, MD]

Any rash that won't clear up completely with that much Diflucan probably isn't yeast.

It's common for people with rashes in skin folds (groin, beneath breasts) to be diagnosed with yeast.  Sometimes they have yeast, and even more often they have an irritative rash.  This responds promptly to a cortisone derivative.

Does this mean you never had yeast?  No, you very likely did.  It means you probably don't have one now.

My suggestion is for your doctor to consider treating you with a mid-range steroid (like triamcinolone 0.1%) for ma week.  That should make the rash go away.  Then you can use a milder steroid for recurrences, which are common but easier to control.  

If you should be diagnosed with yeast again in the future, anti-yeast measures can be added.

But if they don't work, the diagnosis needs to be reconsidered.

Best.

Dr. Rockoff

[ingleside]

Two more things.  

1) My average AM blood glucose is 95 mg/dl.

2) I have been refraining from sex for this duration.  I know that a yeast infection is weakly transmissable.  Do I need to refrain from sex until this is cleared up?

[ingleside]

Also, I am uncircumcised.  During this yeast infection I developed what I guess is called balanoposthitis.  My foreskin swelled to twice or more its normal thickness and was very difficult to retract.  I have never had that occur before.