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Vaginal thrush

Vaginal thrush is a yeast infection that can cause soreness and itching. It’s also known as vulvovaginal candidiasis. Vaginal thrush is common. About seven in 10 women will have it at some point during their lives.

Candida albicans is a type of yeast that usually lives harmlessly in or around your vagina, alongside healthy bacteria. Sometimes, Candida albicans grows more than usual, causing thrush. Occasionally thrush is caused by a different type of yeast.

Some people find that vaginal thrush comes back (reoccurs). If you have thrush with symptoms more than four times in a year, it’s known as a recurrent infection.

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Details

  • Symptoms Symptoms of vaginal thrush

    You may not have any symptoms, and so won’t realise you have vaginal thrush. Possible symptoms include:

    • itching and soreness of your vulva (outside your vagina)
    • thick, white vaginal discharge (like cottage cheese)
    • slight pain during sex
    • pain when passing urine

    If you have severe thrush, it may cause red, cracked or damaged skin.

    If you think you may have thrush, see your pharmacist for advice. If your symptoms get worse or aren't helped by an over-the-counter treatment, see your GP. Thrush isn’t a sexually transmitted infection, but shares some similar symptoms with other infections. If you’re unsure, or have any questions, contact your GP or pharmacist for advice.

  • Diagnosis Diagnosis of vaginal thrush

    Your GP or pharmacist will usually be able to diagnose thrush from your symptoms. He or she may also ask you about your medical history and whether you've had thrush before.

    If over-the-counter treatments haven’t helped your symptoms, your GP may suggest examining you or may recommend a swab test. A swab looks similar to a small round cotton bud and can be used to collect a sample of cells or discharge from your vagina. This is to check you have thrush and not a bacterial infection. The test isn't usually painful, although it may feel a little uncomfortable.

    A swab test is only usually necessary if:

    • you’re at risk of having a different infection
    • your treatment hasn’t worked
    • your symptoms keep coming back

    If you’re sexually active, your GP may take more swabs to test for other infections at the same time. Your GP will then send the swabs to a laboratory for testing.

    If you see a doctor at a sexual health clinic, he or she may also check the pH (acidity) of your vagina with a swab. This might help to tell what is causing your symptoms.

    If you were tested at a sexual health clinic, you may get the swab results immediately. If you were tested at your GP surgery, it can take longer to get the results – sometimes up to a week.

  • Treatment Treatment of vaginal thrush

    Medicines

    Most vaginal thrush infections can be treated with over-the-counter antifungal treatments such as tablets you swallow or vaginal creams or pessaries. These can be bought from a pharmacy or shop. A pessary is a tablet that you put into your vagina, usually at night. Examples of treatments include clotrimazole (Canesten) cream or pessary, and fluconazole (Diflucan) or itraconazole (Sporanox) tablets, which you swallow. You can also get a cream to use outside your vagina (your vulva) to sooth your symptoms.

    Oral treatments for thrush work just as well as vaginal ones. There are some differences though. Oral treatments may take longer to work and cause you to feel sick, have diarrhoea or a headache. Pessaries and creams may relieve symptoms sooner, but can cause irritation and discharge.

    You can buy most thrush treatments from a pharmacy without a prescription. Always read the patient information leaflet that comes with your medicine. If you have any questions, ask your pharmacist for advice.

    There’s a chance your thrush may come back if you don’t finish your treatment. If your symptoms don't improve within a week or two (or your symptoms come back), contact your GP. He or she may take a swab for testing in the laboratory, to check the cause of your symptoms. He or she may also prescribe different antifungal medicines or a longer course of treatment.

    Eight or nine out of every 10 women find that a pessary or oral tablet clears their thrush. If your thrush comes back four or more times a year, you could need treatment for up to six months.

    Sometimes men can get thrush. This can cause them to have an itchy rash and red or white patches on the skin of their penis. Men don’t usually need to be treated for thrush if their partner has symptoms but they themselves don’t. This is because treating a male partner doesn’t make it less likely that a woman’s thrush will come back.

    Special considerations

    If you're pregnant

    See your GP before taking any medicines to treat thrush. It’s likely that they won’t recommend oral antifungal medicines if you’re pregnant or breastfeeding. Instead, your GP will recommend a pessary or cream. Take extra care when you put the pessary into your vagina, as there’s a chance this could damage your cervix (neck of your womb). You may prefer to do this by hand instead of with the applicator.

    If you have diabetes or a weakened immune system

    You may need a longer course of treatment for thrush, so check with your GP.

    If you're sexually active

    Creams and pessaries for vaginal thrush may damage condoms and diaphragms. If you use these for contraception or to protect you from sexually transmitted infections, speak to your GP or pharmacist for advice.

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  • Causes Causes of vaginal thrush

    Vaginal thrush is caused by the amount of Candida albicans yeast in your vagina increasing. There are several things that make vaginal thrush more likely, including:

    • taking antibiotics
    • being pregnant
    • having poorly controlled diabetes
    • having a weakened immune system

    Experts aren’t completely sure whether some types of contraception, such as the combined contraceptive pill, may increase your risk of getting thrush.

    There’s little or no proof that the following factors can cause vaginal thrush.

    • Wearing tight-fitting clothes, or synthetic (non-cotton) underwear.
    • Using soap or shower gel.
    • Douching (washing out your vagina with water or special douching fluid).
    • Using tampons or sanitary towels.
  • Complications Complications of vaginal thrush

    Vaginal thrush does not usually cause any long-term problems. About one in every 100 women have continuous bouts of thrush. If your thrush keeps returning, this may cause you to get depressed and affect your sex life. See your GP if you need advice or have any questions about this.

  • Prevention Prevention of vaginal thrush

    You might be given advice to avoid tight clothing and non-cotton underwear to reduce your risk of getting thrush. You might also be advised not to use soaps and perfumed products in the bath or shower. At the moment, there isn't any proof that avoiding these things helps prevent thrush, so doctors aren't sure how well they work.

    They might be helpful to prevent further irritation while you have thrush. If you’re getting thrush quite often, you may wish to try avoiding these things, to see if this helps.

    If you find that taking antibiotics triggers thrush, you can ask your GP for vaginal thrush treatment at the same time they prescribe your antibiotics. That way, you have the treatment in case you need it.

  • FAQs FAQs

    Can yoghurt or complementary therapies treat vaginal thrush?

    Answer

    At the moment, there isn't enough proof to suggest that yoghurt or herbal therapies (such as garlic or tea tree oil) help to treat thrush.

    Explanation

    Vaginal thrush is caused by the amount of Candida albicans yeast in your vagina increasing. It’s thought that using yoghurt containing healthy bacteria (known as ‘live’ yoghurt) may help reduce the amount of Candida albicans that can grow. Scientists have found that yoghurt or other ‘live’ products don’t really help to prevent or treat the symptoms of thrush.

    There also isn’t enough proof to show that douching (washing out your vagina with water or special douching fluid) helps either. Douching can cause vaginal irritation, so experts don’t recommend it.

    It's important to remember that natural doesn’t always mean harmless. Herbal therapies may interact with medicines or cause side-effects, so be sure to speak to your pharmacist or GP before taking any.

    If I have vaginal thrush, should my partner be treated as well?

    Answer

    Your partner will only need treatment if he has symptoms of thrush.

    Explanation

    A male partner will only need treatment for thrush if he has symptoms too. If you’re a man, things to look out for include the following.

    • A red rash with white patches on your penis. This may itch.
    • Discharge – this may smell.
    • A tighter foreskin than normal.

    These symptoms may be caused by problems other than thrush. Men with these symptoms should visit their GP or genito-urinary (GUM) clinic for advice. GUM clinics are sexual health centres that provide information, testing, contraception and treatment.

    If only you have symptoms, your partner doesn't need treatment. This is because there's no proof that treating a male partner will make your symptoms better or make it less likely that your thrush will return.

    Remember that pessaries and creams for vaginal thrush may damage condoms and diaphragms. Speak to your GP or pharmacist for advice.

    If I get thrush when I'm pregnant, will it harm my baby?

    Answer

    No. Having thrush during pregnancy is common and isn't harmful to your baby.

    Explanation

    Many women develop vaginal thrush during pregnancy. Vaginal thrush won’t harm your baby. It’s important that you see your pharmacist, GP or midwife for treatment, rather than buy it over the counter. If you see a pharmacist, be sure to let them know you are pregnant. This is because treatment for vaginal thrush can be different for women who are pregnant.

    Your GP may prescribe a cream or pessary that you put directly into your vagina. Take care when inserting the pessary so you don’t damage your cervix (the neck of your womb). You may prefer to do this by hand instead of using the applicator.

    If your symptoms haven't improved within a week or two, you should go back to see your GP.
  • Resources Resources

    Further information

    Sources

    • Map of Medicine. Vulvovaginal candidiasis. International View. London: Map of Medicine; 2014 (Issue 2)
    • Candida – female genital. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2013
    • Falagas ME, Betsi GI, Athanasiou S. Probiotics for prevention of recurrent vulvovaginal candidiasis: a review. J Antimicrob Chemother 2006; 58:266–72. doi: 10.1093/jac/dkl246
    • Vaginal and vulval candidiasis. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed July 2014
    • Sexual health and contraception. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014
    • Thrush and bacterial vaginosis. Family Planning Association. www.fpa.org.uk, reviewed January 2014
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed March 2015 (online version)
    • Candidiasis (vulvovaginal). Tea tree oil (intravaginal). BMJ Best Practice. www.bestpractice.bmj.com, published January 2010
    • Balanitis: balanitis in adults. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published January 2014
    • Young G, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database of Systematic Reviews 2001, Issue 4. doi: 10.1002/14651858.CD000225
    • Candidiasis. Medscape. wwww.emedicine.medscape.com, published 6 October 2014
    • Vulvovaginitis. Medscape. www.emedicine.medscape.com, published 27 March 2014
    • Management of vaginal discharge in non-genitourinary medicine settings. British Association for Sexual Health and HIV (BASHH), Faculty of Sexual & Reproductive Healthcare (FSRH). www.fsrh.org, 2012.
    • Candidiasis (vulvovaginal). BMJ Best Practice. www.bestpractice.bmj.com, published 5 January 2010
    • Balanitis. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed April 2014
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