What is vaginal thrush?
Vaginal thrush is a common infection caused by a yeast called Candida albicans. Another name for vaginal thrush is candidiasis. Over one-half of Australian women will have vaginal thrush at least once in their lifetime.
Symptoms of vaginal thrush
These are the symptoms associated with vaginal thrush:
- genital itch - this is the most common symptom of thrush, especially if worse before your period;
- soreness or burning of the vagina during or after sex;
- abnormal discharge - usually thick and white;
- change in the smell of your vaginal secretions;
- redness and inflammation of the vulva;
- soreness or discomfort on urination;
- pain - particularly if thrush is recurrent and inappropriately managed; and
- small white spots on the vaginal wall.
Diagnosis of vaginal thrush
A diagnosis of vaginal thrush is often made based on your symptoms. However, there are many other conditions of the vagina and vulva that have symptoms in common with thrush, so if there is the slightest doubt about the diagnosis, it is essential that your doctor takes a vaginal swab and sends it for analysis before treatment is started.
Treatment of vaginal thrush
One week's treatment with a cream from the anti-candidal group of medicines called azoles, inserted into the vagina every night, is the most effective means of eradicating the yeast from the vagina. These azole creams usually come with an applicator and include miconazole (e.g. Resolve Thrush) and clotrimazole (e.g. Canesten). Even if your period starts you can still use these creams. The creams are available from pharmacies and can be used to treat an isolated episode of thrush - that's one that occurs more than a year since the previous episode - see below for treatment of recurrent thrush.
Vaginal thrush may also be treated with anti-thrush tablets that you take by mouth, but these are usually kept for the most difficult cases and used in conjunction with vaginal treatment, under the supervision of your doctor. Examples of anti-thrush tablets are: Canesoral and Diflucan - these are both brands of a medicine called fluconazole. These are not to be taken by pregnant women.
When should you seek medical advice?
You should see your doctor if:
- this is the first time you have experienced thrush symptoms;
- you are not sure if the problem you have is thrush;
- this is the second thrush infection you have had in less than a year;
- you are pregnant or breast feeding; or
- you have not responded to treatment.
If recurrence of symptoms occurs in less than a year, or your response to treatment is unsatisfactory, do not self-treat or you risk producing a chronic (ongoing) condition. When you see your doctor, make sure that the diagnosis is confirmed with a swab sent to a pathology lab. Please note that swabs may not give any useful results if any treatment has been used in the preceding week or two.
How did I get vaginal thrush?
The yeast that causes thrush, Candida albicans, enters the body via the food you eat. It can live in the bowel without causing any problems. It is spread to the vagina from the anus via the perineum - the area between the anus and the vagina. This is known as perineal spread. Other species of yeast often colonise the vagina but cause no harm. Only Candida albicans causes symptoms of vaginal thrush.
Women are prone to vaginal thrush between puberty and the menopause because, under the influence of the hormone oestrogen, the cells lining the vagina produce a sugar and yeasts (which is what Candida albicans is) are attracted to sugars. That is why thrush is rare before puberty, in breast-feeding women (who are oestrogen deficient), and after the menopause, unless a woman is on hormone replacement therapy (HRT) or has diabetes.
How to avoid getting thrush
Numerous lifestyle changes have been suggested to prevent thrush. These include avoiding sugar and other dietary measures, avoidance of tight clothing, and alteration of sexual practices. None of these have been proven to be effective. Candida albicans is not sexually transmitted.
Antibiotics promote the growth of yeasts, so are best avoided unless really necessary.
Contrary to popular belief, the oral contraceptive pill makes no significant difference to a woman's chances of getting thrush. The long-acting progestogen contraceptives, Depo-Provera (injection) and Implanon (implant), however, do lower the incidence of thrush, because they suppress ovarian production of oestrogen and contain no oestrogen themselves. Breast feeding has the same effect which is why thrush is seldom a problem in breast feeding women.
What if thrush keeps coming back?
A minority of women will get thrush a couple of times a year or more. This is called recurrent candidiasis and is best managed by a doctor with a special interest in the area. This does not necessarily have to be a specialist - many GPs have a special interest in women's health issues and are very knowledgeable about this condition.
If you have recurrent vaginal thrush you should never self-treat. Your doctor should take a vaginal swab with each episode of thrush to monitor your condition. Treatment options for recurrent thrush include:
- combined oral and vaginal azole therapy - this means taking tablets (e.g. fluconazole capsules such as Canesoral or Diflucan) as well as using intra-vaginal anti-candidal creams (e.g. clotrimazole cream such as Canesten);
- long-term (at least 6 months' treatment with an oral azole - tablets or capsules such as Nizoral (ketaconazole), Diflucan (fluconazole) or Sporanox (itraconazole);
- a change of contraception to Depo-Provera (preferably for thrush) or Implanon; and
- a change to a lower oestrogen dose for women taking hormone replacement therapy (HRT).
Thrush is not a sexually transmitted disease. Generally, no benefit is shown by treating the male sexual partner of women with recurrent vaginal thrush. Only in specific circumstances (e.g. balanitis) where swabs have been taken and Candida albicans confirmed, is treatment recommended for men.
2. Sheary B, Dayan L. Recurrent vulvovaginal candidiasis. Aust Fam Physician 2005; 34 (3): 147-150. http://www.racgp.org.au/afp/200503/13323 (accessed Aug 2009).
3. Spence D. Candidiasis (vulvovaginal). Clinical Evidence [online] 2007 [cited February 1]. http://www.clinicalevidence.com. (Accessed 2009 July 31).
4. Dennerstein G. The treatment of Candida vaginitis and vulvitis. Australian Prescriber 2001; 24: 62-4. http://www.australianprescriber.com/magazine/24/3/62/4/. (Accessed 2009 July 17).
5.British Medical Journal Patient leaflet. Thrush. 2009
6. Dr Graeme Dennerstein, personal communication.