Vaginal thrush is a very common vaginal infection caused by an overgrowth of a type of yeast called candida. This organism lives naturally in the bowel and in small numbers in the vagina. It is mostly harmless, but symptoms can develop if numbers increase in the vagina. Thrush needs the hormone oestrogen to thrive so it very rarely occurs in girls before puberty, or in women after menopause (unless they are on hormone replacement therapy). A vaginal thrush infection can be acute (a single episode) or chronic (recurring or persisting for a long time).
WHAT CAUSES A VAGINAL THRUSH INFECTION?
A vaginal thrush infection can occur when normal levels of organism in the vagina increase. The vagina is normally mildly acidic and if the acid balance changes, yeasts which naturally occur in the vagina can multiply and cause symptoms. Thrush can occur for no obvious reason, however there are some things that make thrush more likely:
- Taking certain antibiotics
- Being pregnant
- Having diabetes
- Having sweaty and moist skin
- Having another skin condition (e.g. eczema or psoriasis)
- Immunosuppressive treatment
WHAT ARE THE SYMPTOMS OF VAGINAL THRUSH?
In some instances, the vaginal thrush infection can be present and cause no symptoms at all. In most cases however symptoms are experienced and can include any or all of the following:
- Vulval itching that can be mild or severe
- A white, yeasty-smelling discharge (that looks like cottage cheese)
- Redness or swelling of the vulva
- Vulval soreness
- Vulval pain during intercourse
- Stinging when passing urine
SHOULD I HAVE A TEST FOR THRUSH?
If you have symptoms it is recommended that a swab of the vagina be taken for testing, to determine whether it is vaginal thrush or some other cause. It is also possible to have more than one infection at the same time (e.g. thrush and a sexually transmissible infection). If the problem recurs, and the symptoms are exactly the same, it may not always be necessary to repeat the swab test but if anything is different from a previous episode, a repeat swab may be recommended.
WHAT ARE THE TREATMENTS AVAILABLE FOR THRUSH?
Sometimes symptoms may only last a short time and treatments may not be needed. If treatment is needed there are the following options:
ANTIFUNGAL CREAMS OR VAGINAL PESSARIES
Creams come with applicators, which should be filled and the cream inserted inside the vagina at bedtime. The cream can also be used externally at the same time. Pessaries are tablets or capsules, which can be inserted into the vagina with your finger or with an applicator. Treatment can vary from a single dose to a 3, 6 or 14 night course. It is important to use the full course of cream or pessaries, even if you get your period. These treatments are available from the pharmacist without a prescription.
ORAL TABLETS: SINGLE DOSE
Oral tablets are available as a single dose over the counter in pharmacies and are shown to be as effective as the cream/pessaries. Sometimes your doctor may recommend that you use both the oral tablets and the cream/pessaries.
ORAL TABLETS: EXTENDED TREATMENT
Extended treatment with oral tablets may be prescribed for chronic thrush when the infection is resistant to other treatment or recurring frequently. You will need a prescription for this extended treatment. These drugs are not recommended for use during pregnancy and breastfeeding.
RECURRENT / CHRONIC VAGINAL THRUSH
Recurrence of symptoms should not be ignored. Recurrent/ chronic vaginal thrush is defined as 4 or more episodes in a 12 month period. Although itching, soreness and pain with intercourse can be present there is generally not a great deal of discharge experienced.
The symptoms may be constant and often get worse in the week before menstruation, improving quickly on the first day of bleeding. Treatment of recurrent/ chronic vaginal thrush includes a prolonged treatment with an oral antifungal medicine.
Anyone experiencing symptoms of recurrent/ chronic thrush should see their doctor so tests can be done to ensure the thrush cells are present and the best treatment options can be explored.
HOW CAN I PREVENT IT?
Thrush is a very common infection and most women will have an episode in their lifetime. While there is no known way that is guaranteed to prevent thrush, good vulval care may be helpful. For further information see SHFPACT’s Vulval Care information brochure.
Anyone with a vagina can get vaginal thrush. If thrush is present some practices can contribute to the severity of thrush symptoms, but it should be noted there is little to no evidence they cause the infection. These include:
- Being run down (eating badly, eating a diet higher in sugars, stressed etc.)
- Frequently using vaginal douches or taking bubble baths
- Frequently wearing tight pants/ jeans or pantyhose
- Frequently wearing synthetic underwear (i.e. not cotton) or Lycra swimwear
WHAT ABOUT SEX?
Sexual intercourse is possible when experiencing vaginal thrush, but keep in mind:
- It may be uncomfortable as the vulva and vagina may already be irritated. A burning sensation may be experienced during and after sexual activity. Lubricant can be used to help protect the skin.
- Vaginal thrush is not considered a sexually transmissible infection, but the thrush cells can be passed onto partners resulting in redness and irritation for them afterwards.
- Treatment for thrush can damage latex condoms.
References: The facts about thrush ANZVS/ Australian and New Zealand Vulvovaginal Society Vulval Candida (Thrush) Factsheet/ Australian and New Zealand Vulvovaginal Society Thrush factsheet/ Melbourne Sexual Health Centre Reproductive & Sexual Health: An Australian Clinical Practice Handbook 2nd Ed. 2011