Vaginal thrush (also known as vulvovaginal candidiasis) is a common syndrome caused by an overgrowth of yeast organisms which live naturally in the bowel and also in small numbers in the vagina. Candida is the name of the most common of these organisms. They are mostly harmless, but symptoms can develop if numbers in the vagina increase.
Thrush needs the hormone oestrogen to thrive, so it rarely occurs before puberty or after menopause (unless you are using hormone replacement therapy that contains oestrogen).
A vaginal thrush infection can be acute (a single episode) or chronic (recurring or persisting for a long time).
WHY DOES A VAGINAL THRUSH& INFECTION OCCUR?
A vaginal thrush infection can occur when levels of these yeast organisms in the vagina increase. This can happen when the balance between our immune system and the organisms change. This can occur for no apparent reason; however, some things make it more likely, these include:
- 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?
Sometimes the vaginal thrush infection can be present and cause no symptoms at all. In most cases, however, if you do get symptoms they 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 and burning pain when passing urine
- Skin splits
- Vulval pain and discomfort during sexual intercourse
SHOULD I HAVE A TEST FOR THRUSH?
If you have symptoms, you should see a doctor and have a swab of the vagina 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 the same, you may not need to repeat the swab test before treating it. However, if anything is different from a previous episode, a repeat swab may be recommended.
WHAT ARE THE TREATMENTS AVAILABLE?
Sometimes symptoms may only last a short time, and treatment may not be needed. If you do need treatment, there are the following options:
• ANTIFUNGAL CREAMS OR VAGINAL PESSARIES&NBSP;
Antifungal cream is inserted into the vagina at bedtime using an applicator that comes in the pack. You can also use the cream externally at the same time.
Pessaries are tablets or capsules that you insert into the vagina with your finger or with an applicator.
Treatment with cream or pessaries can vary from a single dose to a 3, 6, or 14-night course. It is essential to use the entire course, 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. They are 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 therapy or is recurring frequently. You will need a prescription from a doctor for this. Oral tablets for thrush are not recommended for use during pregnancy and breastfeeding.
WHAT IS RECURRENT/CHRONIC VAGINAL THRUSH?
Sometimes symptoms of vaginal thrush can keep coming back after treatment. This is called recurrent/ chronic vaginal thrush and is when you have four 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 of chronic thrush may be constant and often worsen the week before menstruation, improving quickly on the first day of bleeding. Treatment of recurrent/ chronic vaginal thrush includes prolonged therapy with oral antifungal medicine.
If you are experiencing recurrent/ chronic thrush symptoms you should see a doctor so a test can be done to confirm it is thrush. Then a decision can be made about the best treatment options for you.
HOW CAN I PREVENT VAGINAL THRUSH?
Thrush is a common infection and having at least one episode in your lifetime is normal. While there is no known way guaranteed to prevent thrush, good vulval care may be helpful (for further information, see SHFPACT’s Vulval Care information brochure). If thrush is present, some things can make symptoms worse, although there is no evidence that they cause the infection.
- Being run down (eating poorly, eating a diet higher in sugar, stress, etc.)
- Using vaginal douches or taking bubble baths
- Frequently wearing tight pants/ jeans or pantyhose
- Frequently wearing synthetic underwear instead of cotton
IS VAGINAL THRUSH A SEXUALLY TRANSMISSIBLE INFECTION?
No, vaginal thrush is not a sexually transmissible infection. The organism that can cause thrush occurs naturally in the bowel and also in the vagina in low numbers. Therefore, anyone with a vagina can get vaginal thrush, including people who have never had sexual intercourse or who don’t have a partner. However, the thrush cells can be passed onto partners resulting in redness and irritation for them afterward.
CAN I STILL HAVE SEXUAL INTERCOURSE WHEN I HAVE THRUSH?
Sexual intercourse is possible when experiencing vaginal thrush, especially if you have few symptoms, but keep in mind:
- It may be uncomfortable as the vulva and vagina may already be irritated. You may experience a burning sensation during and after sexual activity. Using a lubricant can help to protect the skin.
- Treatment for thrush can damage latex condoms.
- 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