Family doctor

Overview:

• Three quarters of all women will experience a thrush infection during their lives
• It is caused by an overgrowth of yeast (candida) in the vagina
• It is not a sexually transmitted disease but can occur after sexual intercourse
• The symptoms include itching, burning and a vaginal discharge
• It is not wise to base a diagnosis on symptoms alone, and tests are needed.
• Some women experience recurring infections
• Most men do not have symptoms
• Local creams or pessaries usually cure the condition

What is vaginal candida? (also known as "thrush")

Vaginal thrush is caused by a fungal infection with candida and is a very common infection for women.

It is estimated that 75 percent of all women will experience a thrush infection at least once in their lives. It is also important to realise that candida may be present in the vagina in approximately 30% of woman (called a commensal) and cause no symptoms at all, as the amounts are small and held in balance by the natural acidity of the vagina.

Other bacteria called lactobacilli are normally present in the vagina and they maintain the vaginal secretions slightly acid, which does not favour the growth of candida.

Thrush is caused by an overgrowth of yeast in the vagina. It is not a sexually transmitted disease, but sexual intercourse can irritate the vagina, causing the condition. Sperm is also alkaline (opposite of acid) and thus favours the growth of candida.

A virgin could have a thrush infection. Babies can sometimes get a mild thrush infection in their mouths or on their bottoms.

Other factors linked to the infection include pregnancy, uncontrolled diabetes, the use of oral contraceptives or antibiotics. Antibiotics alter the natural bacterial balance in the vagina (killing the normal lactobacilli) and allow an overgrowth of thrush. Some women find treating themselves promptly for thrush helpful, when they are on antibiotics.

Wearing tight underwear, douches, and the use of perfumed feminine hygiene sprays may increase the chance of developing an infection.

What are the symptoms?

The symptoms of a yeast infection occur in the genital area. Women complain of itching, burning and pain during urination and/or intercourse.

It is important to realise that these symptoms may occur with many conditions and that up to 75% of patients who see doctors thinking they have thrush, actually have a different condition or another condition as well.

A vaginal discharge is common but not always present. It has been described as having a cottage-cheese, white appearance but it can vary from watery to thick.

Most men do not experience any symptoms of the infection, but about 20 percent of partners of women with thrush have complained of a rash and burning sensation on the penis.

What is the treatment?

Applying an anti-fungal cream (e.g. miconazole cream) to the affected area is likely to be effective, with cure rates of 80 to 90 percent. Many of the common creams may damage condoms and make then weaker.

Common treatments include nystatin, miconazole, clotrimazole.

Pessaries that are inserted in the vagina area also effective.

Wash your hands before inserting a pessary or applicator.

A single dose may be all that is needed for mild disease but those with severe conditions should be treated for five to seven days (occasionally longer).

A single dose of oral medication, fluconazole, can be effective, but is usually not used as a first line of treatment. It can be useful in difficult cases or when creams have not worked in proven thrush infections.

An acidic gel may be helpful to restore the correct acidity in resistant cases.

Bathing in warm salty water can relieve the itch and aid recovery. A doctor may be able to prescribe creams to relieve the pain.

No study has been able to prove that treating the male partners of women will stop reinfection, although it may be advised particularly if the male has some symptoms which have not settled.

Women with recurrent unexplained thrush should see a specialist. Women with HIV may have severe yeast infections that are difficult to cure.

Accurate diagnosis of the condition requires a laboratory test of the vaginal discharge.

Over the counter non-prescription treatments are intended for use only by women with a confirmed history of recurrent thrush due to the common yeast (candida albicans). Self treatment by women thinking they have thrush may delay correct diagnosis and encourage resistant forms of thrush.

How can it be prevented?

Wash and thoroughly dry the genital area at least once a day. Avoid perfumed and coloured soaps, bubble baths and vaginal douches.

Wipe with toilet paper from front to back after a bowel movement.

Do not wear tight clothes or underwear. Some people believe the use of tampons should be avoided because the organism thrives in warm, moist, dark places.

Eating acidophillus yoghurt is recommended by some women to stop yeast infections.

Some women also use plain lacto-bacilli yogurt to the vaginal area, although there is not much scientific evidence to support this (it won't do any harm!).

Having some cream available during a course of antibiotics may be useful.

Creams that increase the vaginal acidity (acigel) may be tried to reduce recurrent thrush.

Future trends

Effective oral medications have recently become available to cure yeast infections. Factors that lead to recurrent thrush are being studied.

Getting help

Thrush treatment is available over the counter in pharmacies.

However, as symptoms may not be an accurate guide, an examination and tests are needed to make an accurate diagnosis and exclude other conditions. The condition is best to be seen by a doctor.