The Lambda Clinic - Sexual Health Advice - Patient Information Leaflet
http://www.lambdaclinic.co.uk/thrush.html
Thrush (Candida Albicans)
What is thrush?
Thrush is caused by a yeast called Candida Albicans. Candida commonly lives harmlessly on the skin and in the gut, mouth and vagina. The body's natural immune system and other harmless bacteria and organisms usually stop candida from thriving. However, in certain conditions, candida overcomes and increases rapidly, causing symptoms.
The conditions candida likes best are moist warm parts of the body. This is why the vagina is a common site for candida infection. Other areas that can become infected with candida include the mouth, groin and nappy area in babies.
How do you get thrush?
More than 50% of all women have at least one episode of thrush in their life and for no apparent reason.
Chances of developing thrush infection are increased if you:
· Taking antibiotics
· Are pregnant
· Being diabetic
· Wear tight clothing e.g. tight jeans
· Have a poor immune system e.g. having steroids, being on chemotherapy, suffer from AIDs
· Using products that may cause irritation e.g. perfumed bubble bath or vaginal deodorant
· Wear synthetic clothing e.g. nylon underwear
· Have anal, vaginal or oral sex with someone who has thrush. Thrush can also be passed on by sharing sex toys and / or by fingers during foreplay.
What are the symptoms of thrush?
Some people do not have any symptoms i.e. being asymptomatic.
Possible symptoms include:
Women
· Itching, soreness, burning and redness around the vulva (outer skin of the vagina), vagina or anus.
· Thick creamy white discharge (cottage cheese type) in the vagina.
· Pain whilst having sex or whilst passing urine.
Men
· Thick creamy white discharge (cottage cheese type) under the foreskin.
· Burning, itching, soreness or redness under the foreskin or on the tip of the penis.
How is thrush diagnosed?
A swab test taken from:
· The genital area
· The vagina and cervix in women
· The foreskin or tip of the penis
Results are usually available within 5 days. Tests for thrush infection are usually very accurate in females. In men the tests can be less accurate and therefore a diagnosis is often made on appearance alone.
Sometimes thrush may be coincidentally noted on a routine cervical smear test but treatment is only required if you have problems with discharge / itching.
What are the treatment options for thrush?
Many women have an occasional bout of thrush. Treatment is usually easy and effective. However, some women have recurring bouts of thrush which may need longer courses of treatment.
Topical treatments
There are various pessaries and creams available which contain anti-yeast medicine such as console, miconazole, clotrimazole or fenticonazole. Creams are applied to the skins area on the outside whereas pessaries are usually a tablet which a woman puts high up into the vagina. These medicines can be bought over the counter without a prescription. Some anti-fungal products can weaken barrier contraceptives such as diaphragms, latex condoms and caps. These types of contraceptives should therefore not be used during treatment for thrush.
Oral tablets
Two main 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. These medicines can be bought over the counter without a prescription. These medicines are not advisable if you are pregnant or breastfeeding.
Topical and oral tablet treatments are equally effective. Tablets are more convenient but are more expensive than topical treatments.
What if treatment for thrush fails?
If you still have symptoms after a week then treatment has failed. This occurs in 20% of cases. Possible reasons include:
· The symptoms are not due to thrush as there are other possible causes of vaginal discharge. Also, thrush can occur at the same time as another infection and therefore taking a vaginal swab can clarify the cause.
· Although most bouts of thrush are caused by candida albicans, in about 10% of cases there are other strains of candida such as candida glabrate that can cause thrush. These are not easily treated with the usual anti-yeast medicines.
· You may have had a recurrence of new thrush infection. This is more likely if you are taking antibiotics or if you have undiagnosed or poorly controlled diabetes.
· You may not have used the medicines correctly.
Some other important points about 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 that these remedies are effective. Thrush is not a sexually transmitted infection. Candida is a yeast which commonly occurs on the skin and in warm moist regions like the vagina. Therefore for reasons unknown it is difficult to understand why the yeast multiples to cause symptoms.
Thrush occurs quite commonly in pregnant women and can be more difficult to treat.
What can I do to prevent thrush recurring?
There can be different triggers which cause vaginal thrush infection. Avoid wearing tight, restrictive or synthetic clothing e.g. nylon underwear, tight jeans or trousers. Loose cotton underwear that allows some 'breathing' are best. Likewise, stockings rather than tights are preferable. The aim is to prevent the vaginal area from being constantly moist, warm and airless.
Thrush is not usually due to poor hygiene. However, the normal conditions of the vagina may be altered by excess washing or douching of the vagina using soaps and bubble baths. When the normal mucus and natural bacteria in the vagina are altered by using these things results in thrush to multiply. Therefore, it may be best to just wash with plain water and unscented soap.
Care should be taken when you clean you anus (back passage). Wipe the anus away from the vagina i.e. from the front to the back. This avoids pushing any infection which may be around the anus into the vagina. This should normally be done in females for general toile ting hygiene.
Although thrush is not a sexually transmitted disease, friction during sex may cause minor damage to the vagina which can allow thrush to thrive. Therefore, making sure that the vagina is well lubricated prevents this particularly if secretions are lacking.
The use of antibiotics increases the chances of getting thrush as antibiotics may kill the normal harmless bacteria in the vagina, which normally help to defend against candida. As candida is a yeast and not a bacteria, the destruction of the harmless bacteria allow candida to thrive.
What is the treatment for recurrent thrush?
If you have recurrence of candida albicans then a longer course of treatment is justified:
· Using one of the treatments described above (topical or tablets) every day for 7 – 14 days, followed by a falcon tablet once per week.
· Or taking traceable tablets once a month (called ‘maintenance treatment').
· Continue maintenance treatment for six months and then stop.
· After maintenance treatment has stopped about half of those treated remain free of thrush, with only some getting the occasional bout of thrush again. The other half return to getting recurrent thrush. However, in these cases the treatment plan can be repeated, and maintenance treatment continued for longer if necessary.
See your doctor if you develop thrush whilst you are on maintenance treatment. This may indicate that you have a resistant strain of candida which may require an alternative treatment.
The Lambda Clinic can help with all aspects of treatments for thrush infection.
BMI The Edgbaston Hospital
22 Somerset Road
Edgbaston
B15 2QQ
Telephone: 0121 452 2815