Sexual Health Advice - Patient Information Leaflets

 

Thrush (Candida Albicans)

Many women have an occasional bout of thrush (candida albicans). Treatment is usually easy and effective. However, some women have recurring bouts of thrush which may need longer courses of treatment.

What is thrush?

Thrush is an infection caused by a yeast called candida. Small numbers of candida commonly live harmlessly on the skin and in the mouth, gut and vagina. The immune system and the harmless bacteria usually stop candida from thriving. However, occasionally conditions change and the yeast increases rapidly causing 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 which are prone to candida infection include the groin, the mouth, and the nappy area in babies.

How do you get 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.

Your chances of developing a thrush infection are increased if you:

  • Are pregnant
  • Are taking antibiotics
  • Your are diabetic
  • You have a poor immune system e.g. people on chemotherapy, high dose steroids, with AIDs
  • Use products that may cause irritation e.g. vaginal deodorant or perfumed bubble bath
  • Wear restrictive clothing e.g. tight jeans
  • Wear synthetic clothing e.g. nylon underwear
  • Have vaginal, anal or oral sex with someone who has thrush. It can also be passed on by fingers during foreplay or by sharing sex toys.

    • What are the symptoms of thrush?

    Some people so not have any symptoms at all and therefore will not be aware that they have a thrush infection.

    Possible symptoms include:

    Women

  • Thick creamy discharge from the vagina that may look like cottage cheese. It often smells like yeast but is not unpleasant. Thrush is the second most common cause of vaginal discharge.
  • Itching, burning, soreness and redness around the vagina, vulva (lips around opening of vagina) or anus.
  • Pain whilst having sex
  • Pain whilst passing urine.

    • Men

  • Thick creamy white discharge under the foreskin, that may look like cottage cheese
  • Itching, burning, soreness or redness under the foreskin or on the tip of the penis
  • Difficulty in pulling back the foreskin.

    • How is thrush diagnosed?

    A doctor or nurse will use a swab to collect a sample of cells. Swabs may be taken from:

  • The vagina and cervix in women
  • The genital area
  • The foreskin in men.

    • The swab is then sent to the lab for testing and the result is available within 5 days.

    Tests for thrush infection are usually very accurate in females. In men however they are less accurate, so diagnosis is often made on appearance alone.

    Sometimes thrush may be noted on a routine cervical smear test but you only need treatment if you have problems with discharge / itching.

    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

    However, see a doctor or nurse if symptoms are different to what you expect, or if the symptoms do not clear with treatment.

    What are the treatment options for thrush?

    Topical treatments

    There are various pessaries and creams available. They contain anti-yeast medicine such as clotrimazole, econazole, fenticonazole or miconazole. The cream is applied externally to the genital area. A pessary is usually a tablet which a woman puts high up into the vagina. You can get topical treatments on prescription, or you can buy them at pharmacies. Some anti-fungal products can weaken latex condoms, diaphragms and caps and they should not therefore be used during treatment.

    Tablets

    Tow 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 pregnant or breastfeeding. You may also want to tub some anti-yeast cream onto the skin around the vagina for a few days, especially if it is itchy.

    Tablet and topic treatments are equally effective. Tables are more convenient, but are more expensive than topical treatments.

    What if treatment for thrush does not work?

    If you still have symptoms after a week from starting treatment, 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 a vaginal swab to clarify the cause of the discharge or other 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 glabrate. These may not be so easily treated with the usual anti-yeast 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 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 germ which commonly occurs on the skin and vagina. For reasons not quite clear, it sometimes multiples 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.

    What can I do to prevent thrush recurring?

    Different people find different triggers cause vaginal thrush infection. If you notice a pattern there may be something you can do about it.

    Avoid wearing tight, restrictive or synthetic clothing e.g. nylon underwear, tight jeans or trousers. Loose cotton pants are best. Stockings rather than tights are preferable. The aim is to prevent the vaginal area from being constantly warm, moist and airless.

    Hygiene. Thrush is not due to poor hygiene. However, the normal conditions of the vagina may be altered by excess washing and douching of the vagina, bubble baths, soaps, genital soaps/ spermicides etc. The normal mucus and bacteria in the vagina may be upset by these things and allow candida to infect. Therefore, it may be best to wash just with water and unscented soap, and do not douche the vagina.

    Toileting. When you clean you anus, wipe with toilet paper from the front to the back. This avoids pushing any candida which may be around the anus (back passage) forward to the vagina.

    Sex. Thrush is not a sexually transmitted disease. However, friction when you have sex may cause minor damage to the vagina which may make thrush more likely to thrive. So, make sure the vagina is well lubricated before having sex. If natural secretions are not sufficient then use a lubricant such as KY jelly when you have sex.

    Antibiotics. Be aware that thrush is more likely if you take antibiotics for other conditions. Antibiotics may kill the normal harmless bacteria in the vagina which help to defend against candida. As candida is a yeast and not a bacteria, this will not be killed by antibiotics. This is not to say that every course of antibiotics will lead to thrush. But, if you are prone to this problem and you are prescribed antibiotics then have some anti-thrush cream ready to ‘nip it in the bud' at the first sign of thrush. Some people also suggest that when you take antibiotics, it may help to have a bath each day and add a couple of tablespoons of vinegar or bicarbonate of soda to the bathwater. This might help to prevent candida from thriving.

    What is the treatment for recurrent thrush?

    If you have recurrence of the usual strain of candida (candida albicans) then your doctor may suggest a longer course of treatment. A treatment plan which is sometimes used is:

  • Use one of the treatments described above (topical or tablets) every day for 7 – 14 days.
  • Then to use a topical treatment or take a fluconazole tablet once per week. Or, take a dose of itraconazole tablets once a month (this is called ‘maintenance treatment').
  • Continue maintenance treatment for six months and then stop.

    • Most women will remain of thrush during maintenance treatment. After treatment is stopped, about half of those treated remain free of thrush, or only get the occasional bout 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.

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