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Candida accounts for approximately one-third of cases of vaginal itch. It may affect otherwisecompletely healthy women and so is general y not considered an opportunistic infection, and,is not considered a sexual y transmitted disease. The problem is enormously common: 50percent of women wil have had at least one episode by age 25, and as many as 75 percentof al premenopausal women report having had at least one episode requiring medicalattention.
Basic Concepts
A form of yeast cal ed Candida Albicans, which can be found in most people without causingany problems at al , causes vaginal thrush. The reservoir for the Candida infection is general ythe gastrointestinal tract, i.e., the gut. Symptomatic thrush occurs when the yeast infects thevagina and grows out of proportion to the other normal vaginal bacteria. Thrush is not asexual y transmitted infection.
A thick white discharge with a "cottage cheese" like appearance Redness or swel ing of the vagina or skin outside the vagina Splitting skin or stinging and burning when passing urine In most people this is easily treated with anti-fungal cream such as Canesten oroccasional y tablets.
Dr Philip Thomas | Patient Information: Candida Dr Philip Thomas Gynaescope PL 2010 Recurrent or Persistent Thrush
Around 5 - 10% of women have recurrent thrush. If you have four or more episodesof thrush in a period of twelve months it is likely that you wil need to seek advice.
Basic Investigations
Basic tests done by your gynaecologist include a speculum examination such as a Papsmear and taking swabs in order to culture the yeast. This is to positively identify the yeastresponsible and to ensure that it is not an alternate form of yeast, which may require adifferent treatment. In some people, diseases such as diabetes may cause recurrent thrushand you may need to be screened for this.
Treatment of recurrent thrush
There are many treatments available to manage the symptoms of recurrent thrush butit is very difficult to eradicate the Candida Albicans from the body. Recurrences are quitecommon. For recurrent thrush, a two-part treatment beginning with suppression and thenmaintenance is used.
This part of the treatment is to relieve symptoms using creams, pessaries or tablets.
Around 80% of people respond to this treatment although some may take longer. General y,anti-fungal creams, pessaries and some oral tablets are available from pharmacies withoutprescription. They typical y contain medications such as clotrimazole, miconazole or nystatin.
Some examples of these treatments include clotrimazole, (e.g. Canesten) creams orpessaries, miconazole (e.g. Monistat) seven-day cream or nystatin (e.g. Nilstat) vaginalcreams or pessaries.
General y, oral tablets are recommended if vaginal treatment is unsuccessful in suppressingsymptoms to a sufficient level. A single dose of fluconazole (e.g. Diflucan 150 mg) can bebought over the counter but to use it more frequently, which is occasional y needed inorder to control recurrent episodes, you wil need a prescription from your gynaecologist.
For some women a cortisone cream applied around the vulva may be prescribed to relieveitching. Some formulations, e.g. Hydrozole cream, contain both an anti-flammatory cortisonecream and anti-fungal cream.
Dr Philip Thomas | Patient Information: Candida Dr Philip Thomas Gynaescope PL 2010 Tablets and creams are equal y effective. Creams may be messier to use. Many women preferoral tablets but these are more expensive and should not be used in breastfeeding orpregnancy. General y a prolonged course of oral tablets wil require supervision by me.
Maintenance Therapy
Is intended to keep symptoms at a reasonable level and prevent flare-ups. Either creams,pessaries or tablets can be used and it may be necessary to use this treatment for threeto six months. Regular, intermittent therapy can also be used to prevent recurrences. Thetreatment interval may vary from weekly to once a month depending upon your response.
Some women have premenstrual exacerbations of Candida and so taking a Diflucan or usinga vaginal pessary before periods may be very useful. Fluconazole, Mitroconazole or Canestenand Nilstat pessaries can al be used for long-term maintenance therapy.
Around 50% of women wil experience a recurrence of their symptoms. Another treatmentfol owed by a maintenance course may be necessary.
Other Causes of Thrush
Sometimes symptoms do not resolve because they are caused by an unusual kind of yeast,which responds less wel to the usual treatment. An example of this is Candida Glabrata. Inthis case fluconazole tablets are not recommended. We occasional y use Boric acid pessariesvaginal y for one to two weeks. These work by lowering the vaginal pH, which provides anenvironment that is not suitable for yeast to grow. Nystatin cream or pessaries may also behelpful. If an unusual kind of yeast is suspected then cultures for this wil need to be takenand the identity of the yeast wil need to be confirmed by a pathology laboratory. If you haverecurrences, even though your general practitioner may already have taken cultures, thesewil general y be repeated for this reason.
Antibiotic Therapy
It is common to experience an exacerbation of thrush after antibiotic tablets. This is becausethe balance of bacteria within your gastrointestinal tract is altered, al owing another growthof Candida, which may then infect the vagina. Some women find a preventative fungal creampessary or use of probiotics such as Yakult to be useful in this circumstance although thereis no hard and fast scientific data.
Dr Philip Thomas | Patient Information: Candida Dr Philip Thomas Gynaescope PL 2010 Clothing - What to Avoid
Candida thrives in a moist, warm environment. It is for this reason that exacerbations arefrequent during pregnancy. You should avoid tight jeans; synthetic underwear or clothing thatmay lead to sweating. Cotton underwear is recommended. After a recurrence of Candida,boiling underwear or clothes has also been suggested but this has not proven to be helpfuland may obviously damage your clothes.
Your Partner
It is not general y necessary that your partner be treated unless he also has symptoms.
Sometimes it may seem that an exacerbation of Candida is linked to sex however this isgeneral y due to subtle damage to the lining of the vagina rather than direct transmissionfrom a male partner. You should therefore make sure that you use a lubricant during sex,which wil limit skin abrasion.
Other Factors in Current Candidiasis
The PillIt is not truly known whether the contraceptive pil can cause recurrent thrush. Some womenfind thrush to be more of a problem since starting the OCP especial y with those pil s highin oestrogen. There is certainly some theoretical basis for this and if you feel that yoursymptoms have increased with the introduction of the pil , then we may need to changepreparations.
Injectable Contraceptives (e.g. Depo-Provera)Progesterone contraceptives work partly by causing a drying of secretions and may behelpful in managing recurrent thrush.
Vaginal Contraceptive Ring (NuvaRing)This device may encourage the growth of bacteria in the vagina which limits Candidainfection however there is insufficient evidence that this is a beneficial treatment in casesof recurrent Candida.
Dr Philip Thomas | Patient Information: Candida Dr Philip Thomas Gynaescope PL 2010 Natural Remedies
Most of these methods have not been proven in trials to be beneficial.
The fol owing are unlikely to do you harm but there is not enough evidence to recommendthem on a general basis as a cure for thrush: Ariel - 4% acetic acid can be bought from the chemist. The aim is to restore thevagina's acidity and therefore prevent overgrowth of Candida.
Yoghurt or Lactobacil us - It has been suggested than inserting a tampon slatheredwith yogurt may be a treatment for thrush but this is unproven and certainly is verymessy. There is more evidence that women who eat large quantities or yogurt orpreparations such as Yakult have a decrease in their symptoms.
There is no proven link between thrush and diet. There is no evidence that avoiding alcohol,sugars, bread, mushrooms or other yeast containing foods results in a decrease in thrushhowever if you feel that a certain food definitely makes you worse, then it cannot harm to try.
Hygiene Measures and Washing
Daily washing is sufficient. Excessive washing, especial y using antiseptics or conventionalsoaps is usual y harmful as it removes beneficial bacteria from the vagina and often irritatesthe vaginal lining (mucosa). You should avoid vaginal deodorants, perfumes, soaps or bubblebaths and strictly use a soap-free bath or shower gel.
Garlic Pessaries
There is insufficient evidence to recommend garlic pessaries.
Dr Philip Thomas | Patient Information: Candida Dr Philip Thomas Gynaescope PL 2010 Remedies that may be harmful
The fol owing remedies have been known to cause harm in people: Tee-Tree oil. There are no studies to confirm the helpfulness of tee-tree oil. It canhowever be extremely irritating to the vaginal mucosa and is not recommended.
Gentian Violet - There is a smal amount of evidence that the use of Gentian Violet maybe successful in treating thrush. However, it is very messy at leaving purple stains onthe clothes and often also causes irritation around the vagina. It may also causeulceration and in studies in France, has caused cancer.
Vaginal Douches
Not recommended and may be harmful. Wil almost certainly change the vaginal bacteria forthe worse.
Recurrent Candidiasis is common, is not linked to any particular foods and is not sexual ytransmitted. Eradication may sometimes require recurrent and prolonged causes of anti-fungals. Long-term intermittent suppressive therapy may be needed.
Dr Philip Thomas | Patient Information: Candida Dr Philip Thomas Gynaescope PL 2010



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