Vaginal Thrush

Many women have an occasional bout of vaginal thrush. It is due to an infection with a yeast fungus called Candida spp. Treatment options include a tablet that you can take by mouth, or anti-thrush pessaries that you can insert into the vagina. There is also anti-thrush cream that you can rub on to the skin around the vagina (the vulva) if needed. Treatment usually works well. However, some women have recurring bouts of thrush which may need longer courses of treatment.

Thrush is an infection caused by a yeast fungus called Candida spp. Small numbers of Candida spp. 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 spp. from thriving. However, when conditions are good for Candida spp., numbers multiply and may invade the vagina and cause symptoms.

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

Most causes of thrush are a result of Candida albicans but sometimes other types of Candida spp., such as Candida glabrata or Candida tropicalis, are the cause.

Thrush is the second most common cause of a vaginal discharge. (The most common cause of vaginal discharge is bacterial vaginosis. A separate leaflet called 'Bacterial Vaginosis' gives more details.)

The discharge from thrush is usually creamy white and quite thick, but is sometimes watery. It can cause itch, redness, discomfort, or pain around the outside of the vagina (the vulva). The discharge from thrush does not usually smell. Some women can have some pain or discomfort whilst having sex or whilst passing urine if they have thrush.

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, thrush will not harm your baby.

More than half of all women will have at least one bout of thrush in their life. In most cases it develops 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 candidal infection (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. So, in these situations, you may be more likely to develop thrush.

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

You do not always need a test to diagnose thrush. The diagnosis is often based on the typical symptoms and signs. However, it is important that you 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. The swabs are then sent to the laboratory to confirm the cause of the discharge.

Topical thrush treatment

These are pessaries and creams which you insert into the vagina with an applicator. They contain anti-yeast medicines such as clotrimazole, econazole 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-thrush cream on to 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 information leaflet that comes with the treatment for full information.

In general, you can use these topical treatments if you are pregnant but you should always check with your doctor or pharmacist. Treatment may be needed for longer during pregnancy.

Note: some pessaries and creams may damage latex condoms and diaphragms and affect their use as a contraceptive.

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 without a prescription from pharmacies. Side-effects are uncommon, but always read the information leaflet that comes with the treatment for full information. Do not take these treatments if you are pregnant or breast-feeding. You may also want to rub some anti-yeast cream on to the skin around the vagina for a few days, especially if it is itchy.

Note: tablets and topical treatments are thought to be equally effective. Tablets are more convenient, but are more expensive than most topical treatments.

Other things that may help

If you have thrush, you may also find the following things help to relieve your symptoms:

  • Avoiding wearing tight-fitting clothing, especially clothing made from synthetic materials. Loose-fitting, natural fibre underwear may be better.
  • Avoiding using perfumed products around the vaginal area, such as soaps and shower gels, as these may cause further irritation.

If you still have symptoms a week after 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 is caused by other strains of Candida spp., 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.)
  • '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, at present there is little scientific evidence to show that these remedies work but some women may find that they help soothe their symptoms.
  • Thrush is not a sexually transmitted infection. Candida spp. 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 having an episode of thrush four or more times in a year. If this occurs, see your doctor for advice on preventative treatment. (See also the separate leaflet called 'Thrush - Recurring Vaginal'.)

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) without a prescription from pharmacies.

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.
  • Have 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.
  • Have a weakened immune system - for example, if you are on chemotherapy treatment for cancer or are taking long-term steroid medication for whatever reason.

And if you do treat yourself, see a doctor or nurse if the symptoms do not clear with treatment.

Original Author:
Dr Tim Kenny
Current Version:
Peer Reviewer:
Dr Tim Kenny
Last Checked:
15/03/2012
Document ID:
4350 (v41)
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