Thrush is a very common fungal infection which is irritating and annoying rather than harmful. It is caused by a yeast (called Candida) which lives naturally in the bowel and in small numbers in the vagina.
In normal numbers the candida organism does not usually cause any symptoms.
Women with an overgrowth of candida may experience:
Thrush is not the only cause of these symptoms-other vaginal conditions may lead to similar symptoms. The diagnosis of thrush can only be made accurately after a doctor examines the genitals and takes swab specimens from the affected area.
Sex is not thought to be important in transmitting thrush. The symptoms occur as a result of overgrowth of the organism which is already present normally.
Overgrowth of candida may be associated with:
Often the reason for an outbreak of thrush cannot be identified.
Treatment is aimed at reducing the number of organisms so that they can no longer cause symptoms. Sometimes symptoms only last for a short time (e.g. in the week before a period) and treatment is not necessary. Treatment is with suppositories or cream which are placed directly in the vagina at night time. If your period occurs during treatment, continue to use the suppositories.
There is no evidence that dietary changes will help prevent thrush.
Some women experience repeated episodes of thrush, despite following the guidelines above. This may result in many visits to the doctor and many courses of treatment.
In such cases, it is important for a doctor to establish that the symptoms are genuinely due to thrush, rather than some other vaginal condition.
Once this has been done, any of the possible influences contributing to thrush should be identified and eliminated.
If recurrent thrush has been confirmed and there are no identifiable predisposing factors, a course of preventative treatment is usually effective in stopping further outbreaks.
Thrush is a very common condition and it is not sexually transmitted. Your general practitioner is the best person to consult if you have another attack in future.
The yeast-like organisms that cause candidiasis are very common and normally occur in the vagina as well as the mouth and in the intestines of most healthy people. Candida is not a classic STD, but is seen most commonly in sexually active people. The presence of candida does not usually cause symptoms, but a change in the pH of the vagina may cause a disturbance in the balance of normal flora. As a result, candidal overgrowth can occur and then cause symptoms. Heat and moisture, diabetes, steroid medication, and lowered resistance from, for example, cancer, chronic infection, and malnutrition can also lead to symptoms.
Men can also get candidiasis, which is one of the causes of balanitis (inflammation of the glans penis). This is usually seen in uncircumcised men who still have a foreskin to provide moist conditions for candidal overgrowth.
A swab can be taken from the wall of the vagina and examined by microscope and a culture grown.
It is possible to change some of the factors that predispose the organism to spread.
Acute vaginal candidiasis is treated with an anti fungal agent in the form of either a pessary (capsule) of nystatin which is inserted into the vagina, or a vaginal cream.
As an alternative, natural yoghurt can be inserted into the vagina or a vinegar and water douche can be used¡ªone part vinegar to five parts water.
A combination of genital and oral antifungal therapy can be effective in recurrent infections by eradicating reservoirs of the infection, however thrush can always recur because candida lives in the bowel and genital tract. Candida cannot be permanently eradicated.
Careful washing and drying of the anal and genital area using minimal soap, are important in management of the infection. It is also important when using toilet paper after both urination and defecation, to wipe from front to back to reduce the risk of reinfection. Loose-fitting cotton underwear is best, and nylon pantyhose and tight trousers need to be avoided.
| Budding cells or hyphae detected on a KOH preparation or Gram stain. Culture on chromagen agar is more sensitive than smear. |
and
Symptoms and/or signs of vaginitis, eg discharge, vaginal itch or discomfort, dysuria, vulvovaginal erythema.
Treatment is provided only for symptomatic women.
Treatment
Seven day regimens are preferred.
miconazole 100 mg pessaries or cream 2% intravaginally at night for 7 nights
or
clotrimazole 100 mg pessaries or cream 1% intravaginally at night for 7 nights
Nil. The patient should return for any other laboratory results.
The occurrence of at least four mycologically proven symptomatic episodes of candidal vaginitis within 12 months, with the exclusion of other common vaginal pathogens.
Identical to acute vulvovaginal candidiasis.
Exclude associated factors such as pregnancy, uncontrolled diabetes mellitus, hormone therapy (including oestrogens or corticosteroids), HIV infection and repeated courses of broad-spectrum antibiotics.
Most sufferers of recurrent candida will already know about avoiding tight-fitting or synthetic underwear, and not using douches or vaginal deodorants.
Treatment
Suppressive prophylaxis using a long term maintenance regimen is needed. One of the following regimens is suggested:
clotrimazole 500 mg pessaries intravaginally at night, once weekly for six months
or
ketoconazole 400 mg orally daily for 5 days after the onset of menses, over a six month period
or
fluconazole 150 mg orally once monthly for six months
or
ketoconazole 100 mg orally daily for six months
Routine treatment of partners is unlikely to reduce recurrence rates.