Vaginal thrush is a common yeast infection that affects most women at some point
What is vaginal thrush?
Vaginal thrush is a common condition caused by a yeast infection in the vagina and surrounding area.
The infection is usually Candida albicans, but is also known as candida or vulvovaginal candidiasis.
Candida lives harmlessly on the skin, in the mouth, gut and vagina and is normally kept under control by harmless bacteria.
But sometimes conditions change and the yeast increases rapidly, causing symptoms of discharge and irritation.
Who gets thrush?
Most women get thrush at some point in their life, but it is most common in women in their thirties and forties, and in those who are pregnant.
It is not clear why some women are more prone to thrush than others. Diabetes and medical conditions that cause problems with the body’s immune system increase the likelihood of it occurring.
Other potential triggers include:
- wearing tight clothing – this prevents natural ventilation
- taking antibiotics – about 30 per cent of women will have thrush because of this
- using products that irritate the vagina, such as vaginal douches or bubble bath
- having chemotherapy.
There is little evidence that using sanitary towels or tampons is a risk factor for developing thrush.
Although not usually thought of as a sexually transmitted disease, thrush can sometimes be passed on to your partner after vaginal, oral or anal sex, during foreplay or by sharing sex toys.
What are the symptoms of thrush?
Some women with thrush will not have any signs or symptoms, and be completely unaware they have thrush. It may only be picked up by chance when you go for a cervical smear test.
In women, typical symptoms include:
- vulval itching, soreness and irritation
- redness of the vagina and vulva
- vaginal discharge, often white (like cottage cheese) and this can be thick or thin but is usually odourless
- pain or discomfort during sex or when passing urine.
In men, symptoms may be less noticeable than in women, but include:
- discomfort, burning or itching at the tip of the penis or under the foreskin
- redness or red patches on the penis or under the foreskin
- a thick or thin discharge, like cottage cheese, under the foreskin
- discomfort when passing urine.
How is thrush diagnosed?
This is not a condition you should diagnose yourself – see your GP if you think you might have symptoms of thrush.
Your GP will check your symptoms and if unsure, will do a simple test to confirm the diagnosis.
This is a simple and painless procedure, done in the surgery, and involves using a cotton swab to take a sample of cells from the vagina or penis. The swab is then sent to the local laboratory for analysis.
The test will also show if the symptoms are being caused by other common conditions, such as bacterial vaginosis or trichomonas.
Most doctors will treat thrush without testing because the symptoms of thrush are usually obvious.
Thrush is not viewed as a sexually transmitted infection, so your partner will not need to be tested or treated unless he or she also has symptoms.
How is thrush treated?
If symptoms are mild, your doctor will usually recommend a short course of antifungal medicine, usually for one to three days.
If the symptoms are more severe, the treatment course will be longer.
A variety of treatment options are available including taking tablets orally, inserting them into your vagina (pessaries) or using a cream. Tablets and pessaries work equally well.
Your GP can prescribe these treatments and you can also buy them over the counter.
Tablet antifungal treatment is typically fluconazole (eg Canesten oral, Diflucan).
They can be extremely effective, and one tablet taken once may be enough to cure an episode of thrush.
Occasionally they cause side-effects such as nausea and vomiting, diarrhoea or constipation and bloating.
Pregnant or breastfeeding women are not usually prescribed tablet antifungal treatments because of the theoretical chance they may affect the baby.
Intravaginal pessaries do not cause as many side-effects as tablet treatments, but they can be awkward and messy to use, can cause local irritation, and can damage latex condoms and diaphragms.
The medicines clotrimazole (eg Canesten), econazole (eg Ecostatin) and miconazole (Gyno-Daktarin) come in pessary form.
If you are pregnant, don’t use the applicator to insert the pessary because there is a risk of causing injury to the cervix. Instead, insert the pessary by hand.
Creams can be used in addition to pessary or tablet treatment if there is localised redness and soreness around the vagina and vulva.
When should I go back and see my doctor?
Don’t use the products you can buy over-the-counter long term without seeking medical advice. If symptoms do not improve within 14 days, see your GP.
Always go back to see your GP if:
- symptoms come back
- you are a teenager or over 60
- you are pregnant
- you have previously suffered from a sexually transmitted infection.
Symptoms that should always be checked out without delay include abnormal menstrual bleeding, lower abdominal pain, a bloodstained discharge and vaginal ulcers or blisters.
What if thrush keeps coming back?
Short courses of antifungal medication don’t work for up to one in five women. Your GP will consider treatment to have failed if your symptoms don’t clear up within 7 to 14 days.
If this happens, your GP may recommend you take a regular ‘maintenance dose’ of antifungal treatment.
Recent studies have shown such a strategy can significantly help reduce the recurrence of thrush.
Using a tablet of fluconazole once a week appears to be effective in preventing thrush from coming back.
What can I do to prevent thrush?
As well as using antifungal medicines, there are a number of things you can do to help ease thrush.
- Wash your vaginal area with non-perfumed soap and water, or water alone. Avoid using highly-scented soaps, shower gels, vaginal deodorants or douches.
- Avoid using latex condoms, spermicidal creams and lubricants if they cause irritation. Instead, try using non-allergenic condoms.
- Avoid wearing tight-fitting clothes made of artificial fibres such as nylon.
- Whenever possible, wear cotton underwear and loose-fitting clothes rather than tight ones.
Some women who suffer regularly from vaginal thrush use live yoghurt – either as a cream or on a tampon – to help treat it.
Although there is no firm medical evidence that this type of treatment is effective, there is no reason to believe it is unsafe and many women report significant relief of symptoms.