Vaginal Thrush

Thrush is an infection caused by a yeast called Candida. Small numbers of Candida commonly live on the skin and around the vaginal area. These are usually harmless. The immune system and the harmless bacteria that also normally live on the skin and in the vagina usually stop Candida from thriving. However, when conditions are good for Candida, it multiplies and may invade the vagina and cause symptoms.

The conditions Candida likes best are warm, moist, airless parts of the body. This is why the vagina is the most common site for Candida infection. Other areas of the body that are prone to Candida infection include the groin, the mouth, and the nappy area in babies.



What are the symptoms of vaginal thrush?
Thrush is the second most common cause of a vaginal discharge. (The most common cause of vaginal discharge is bacterial vaginosis.) The discharge from thrush is usually creamy white, but is sometimes watery. It can cause itch, redness, discomfort, or pain around the outside of the vagina (the vulva). Sometimes symptoms are minor and clear up on their own. Often symptoms can be quite irritating and will not go without treatment.

Thrush does not damage the vagina, and it does not spread to damage the uterus (womb). If you are pregnant it will not harm your baby.

Who gets vaginal thrush?
More than half of all women have at least one bout of thrush in their life. In most cases it develops 'out of the blue' for no apparent reason. However, certain factors can make thrush more likely to develop. The vagina contains mucus and some harmless bacteria which help to defend the vagina from Candida (and other germs). These natural defences may be altered or upset by certain situations. For example: when you are pregnant, if you have diabetes, or if you take antibiotics.

People with a poor immune system are also more likely to get thrush. For example, people on chemotherapy, people taking high dose steroids, etc.



Do I need any tests?
Usually not. The diagnosis is usually based on the typical symptoms and signs.

However, do not assume that a vaginal discharge is thrush. There are other causes of vaginal discharge. If you have never had thrush before, then see a doctor or nurse to confirm the diagnosis and for advice on treatment. The doctor or nurse may examine you. No tests may be necessary if the symptoms and signs are typical. However, the doctor or nurse may take small samples of the discharge with swabs if the cause of the discharge is not clear. These is sent to the lab to confirm the cause of the discharge.

What are the treatment options for vaginal thrush?
Topical treatments
These are pessaries and creams which you insert into the vagina with an applicator. They contain anti-yeast medicines such as clotrimazole, econazole, fenticonazole, or miconazole. Commonly, a single large dose inserted into the vagina is sufficient to clear a bout of thrush. However, you may also want to rub some anti-yeast cream onto the skin around the vagina (the vulva) for a few days, especially if it is itchy. You can get topical treatments on prescription, or you can buy them at pharmacies without a prescription. Side-effects are uncommon, but read the product label for full information. You can use topical treatments if you are pregnant.

Tablets
Two options are available. Fluconazole, which is taken as a single dose, or itraconazole which is taken as two doses over the course of one day. You can get these treatments on prescription, and you can also buy fluconazole from pharmacies without a prescription. Side-effects are uncommon, but always read the product label for full information. Do not take these if you are pregnant or breastfeeding. You may also want to rub some anti-yeast cream onto the skin around the vagina for a few days, especially if it is itchy.

Tablets and topical treatments are equally effective. Tablets are more convenient, but are more expensive than most topical treatments.

What if the treatment does not work?
If you still have symptoms after a week from starting treatment, then see your doctor or nurse. Treatment does not clear symptoms in up to 1 in 5 cases. Reasons why treatment may fail include:

The symptoms may not be due to thrush. There are other causes of a vaginal discharge. Also, thrush can occur at the same time as another infection. You may need tests such as vaginal swabs to clarify the cause of the symptoms.
Most bouts of thrush are caused by Candida albicans. However, about 1 in 10 bouts of thrush are caused by other strains of Candida such as Candida glabrata. These may not be so easily treated with the usual anti-thrush medicines.
You may not have used the treatment correctly.
You may have had a quick recurrence of a new thrush infection. (This is more likely if you are taking antibiotics, or if you have undiagnosed or poorly controlled diabetes.)
Some other points about vaginal thrush
'Natural' remedies for thrush include: live yoghurt inserted into the vagina; adding vinegar or bicarbonate of soda to a bath to alter the acidity of the vagina; tampons impregnated with tea tree oil. However, there is little scientific evidence to show that these remedies work.
Thrush is not a sexually transmitted infection. Candida is a yeast germ which commonly occurs on the skin and vagina. For reasons not quite clear, it sometimes multiplies to cause symptoms.
Male sexual partners do not need treatment unless they have symptoms of thrush on their penis. Symptoms in men include redness, itch, and soreness of the foreskin and the head (glans) of the penis. Women do not 'catch' thrush from men who have no symptoms.
Thrush occurs more commonly in pregnant women, and can be more difficult to clear. It can take several days of topical treatment to clear thrush if you are pregnant.
Some women develop recurring thrush. This is defined as four or more times a year. If this occurs, see your doctor for advice on preventative treatment. (See also the leaflet called 'Recurring Vaginal Thrush'.)
Do I need to see a doctor if I get vaginal thrush again?
If you have had thrush in the past and the same symptoms recur, then it is common practice to treat it without an examination or tests. Many women know when they have thrush and treat it themselves. You can buy effective treatments (discussed above) from pharmacies without a prescription.

However, remember, a vaginal discharge or vulval itch can be due to a number of causes. So, do not assume all discharges or itch are thrush. The following gives a guide as to when it may be best to see a doctor or nurse if you think that you might have thrush. If you:

Are under 16 or over 60 years of age.
Are pregnant.
Have abnormal vaginal bleeding or lower abdominal pain.
Are unwell in yourself in addition to the vaginal and vulval symptoms.
Have symptoms that are not entirely the same as a previous bout of thrush. For example, if the discharge has a bad smell, or it you develop ulcers or blisters next to your vagina.
Have had two episodes of thrush in six months, and have not consulted a doctor or nurse about this for more than a year.
Have had a previous sexually transmitted infection (or your partner has).
Have had a previous bad reaction to anti-thrush medication or treatments.