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About Vaginal Thrush

What are the symptoms of vaginal thrush?

The main symptom of thrush is a vaginal discharge, which will be white in colour, but should not have an offensive smell. This may be accompanied by irritation, itching, soreness, and redness of the surrounding area, which can cause discomfort during intercourse. Whilst a clear vaginal discharge is quite normal in women, especially during the second half of each monthly cycle, a white curdy discharge would suggest an attack of thrush, especially if the above symptoms are experienced at the same time.

Vaginal thrush is a common complaint in women of childbearing age, as the oestrogen in the blood during the reproductive years encourages a slightly acidic vaginal environment, which favours the growth of the Candida fungus.

It's important to differentiate the symptoms of thrush from those of cystitis, as the treatments for the two are quite different. Cystitis (an infection of the lower urinary tract) is associated with pain on passing water, and a need to pass water more frequently than normal, and does not produce any unusual vaginal discharge. Similarly, if the vaginal discharge has an unpleasant smell, this may be caused by a bacterial rather than a fungal infection, and should be referred to your doctor.

If you are unsure of the nature of your symptoms, ask a pharmacist for advice. 

What are the causes of vaginal thrush?

Vaginal thrush is caused by an infection with the Candida fungus. This is an organism that is normally present on the skin, but which is kept in check by the action of the immune system and also the presence of other harmless organisms. There are many factors that can cause a thrush infection, either by improving the environmental conditions necessary for the growth of the Candida fungus, or by weakening the body's immune capacity – the most common factors are listed below:

· Pregnancy – hormonal changes in the body during pregnancy alter the conditions in the vagina, which make the growth of the Candida infection more likely. As many as one in five pregnant women will experience the symptoms of thrush, which in this case should be referred to the doctor.

· Antibiotics – a course of a wide-spectrum antibiotic, such as penicillin, may kill not only the intended bacterial infection, but also harmless bacteria that are normally resident in the vagina and whose presence stops the Candida fungus from multiplying.

· Oral contraceptives – the oral contraceptive pill is thought to increase the likelihood of thrush. Opinion is divided as to whether this is due to a reduction in the level of vaginal secretions, or because women taking the oral contraceptive pill are more likely to be sexually active and not using a barrier method of contraception.

· Other drugs – some medicines that can reduce the body's immune response, including steroid tablets, may make an overgrowth of the Candida fungus more likely.

· Diabetes – diabetics are more prone to thrush infections. This is thought to be caused by sugar in the urine which would encourage Candidal growth in the vagina, and is therefore most common in undiagnosed or poorly controlled diabetics. Recurrent thrush may be a symptom of undiagnosed diabetes and should be seen by the doctor.

· Clothing – frequently wearing tight clothing, tights, or nylon pants can increase the chance of a thrush infection.

· General health – thrush may be more likely in those who are constantly run down or stressed, or who eat a poor diet, because of the detrimental effect upon the immune system.

· Personal hygiene products – vaginal douches, and personal deodorants and sprays can irritate the area, or generate an allergic response, which could lead to a thrush infection. Similarly, frequent hot, soapy baths and perfumed bubble bath products can remove the normal secretions and alter the vaginal environment, making conditions more favourable for the Candida infection.

What complications might occur?

A simple case of vaginal thrush can be treated quickly and successfully using non-prescription medicines, and it's very unlikely that it will lead to any further complications. However, it's very important that the difference between thrush and cystitis is understood – cystitis may initially present with similar symptoms to those of vaginal thrush, but if left untreated cystitis may lead to further complications. The article on cystitis  offers further information.

You should see your doctor in any of the following circumstances:

· Women over 60, or under 16 – vaginal thrush is rarer in this group of women and the doctor should be consulted to exclude other possible causes before thrush is diagnosed.
· Men – thrush is not a common infection in men and any signs of thrush should be referred to exclude any other possible causes.
· Pregnancy or breastfeeding – whilst thrush is common during pregnancy, non-prescription medicines are not licensed for use in this group of women. The safest and most effective treatment should be recommended by your doctor.
· First time sufferers
· Frequent sufferers – more than two attacks during the previous six months
· Vaginal discharge that smells unpleasant or contains traces of blood
· Blisters, sores, or ulcers around the vaginal area
· Thrush that has not responded to non-prescription treatment after one week of use
· Any stomach or lower abdominal pain
· A previous history of a sexually transmitted disease

How can I treat vaginal thrush?

The best way to deal with a thrush infection is to treat it using a non-prescription antifungal preparation, as long as this is appropriate. There are many steps you can take to relieve the discomfort of thrush, and to prevent its recurrence:

· To avoid bacteria from the lower bowel entering the vagina, wipe from front to back after using the toilet.

· Wear loose-fitting clothes, and cotton underwear, to allow air to circulate more easily; change your underwear after exercising.

· Avoid perfumed bath products or over-use of personal deodorants.

· Taking a shower, rather than a bath, may help in some cases.

· Abstain from sex until the infection is successfully treated.

· Live plain yoghurt contains harmless bacteria which, if eaten or applied to the vagina, may restore the balance of microorganisms and discourage the growth of the Candida fungus.

· If you are prone to thrush infections, inform your doctor of this if you are ever prescribed antibiotics.

Which treatments can I buy for vaginal thrush?

Antifungal treatments for vaginal thrush can now be purchased from pharmacies without a prescription, and are very successful at treating the condition quickly. They can be separated into two groups: topical preparations, for application to the affected area, and oral preparations. 

Topical preparations
Non-prescription topical products for the treatment of thrush contain either clotrimazole, miconazole, or econazole (Ecostatin, Pevaryl), all of which are strong antifungals and can be purchased in a number of different forms.

Creams can be found either in a tube for the relief of external symptoms, to be used each day, or in a special vaginal applicator to treat the cause of the problem. Internal tablets (pessaries) can also be purchased with an applicator, and work in the same way.
Internal preparations only need to be used once, at bedtime, and will treat the underlying fungal infection – symptoms will typically have disappeared within three to five days. If one application does not work, you should contact the doctor for further advice.

It's quite possible that the thrush infection will be passed to the male partner, and for this reason an external antifungal cream should be applied to the penis twice daily, for six days – noticeable symptoms in the male are uncommon, but the infection may still re-infect the female if left untreated.

Oral preparations
There is currently one oral treatment for vaginal thrush available without a prescription, which is based on an ingredient called fluconazole (Diflucan One). This has the advantage of being much easier to use – it can be taken with a glass of water at any time of day – and symptoms should be treated within three to five days. An external thrush cream may be used at the same time, if necessary. It may only be used without a prescription in women over 16 and under 60, and as with all thrush treatments, you should consult your doctor if you are pregnant or breastfeeding.

What additional investigations might be needed?

The doctor will first establish the nature of the infection that is causing the symptoms, which may involve taking a swab from the affected area for analysis. If the infection is not fungal in origin, the appropriate treatment will be recommended or prescribed.

As mentioned above, the symptoms of vaginal thrush must be differentiated from bacterial infections such as cystitis, or sexually transmitted diseases, some of which can cause a similar discharge and are treated in different ways.