What is vaginal thrush?
Vaginal thrush is a common infection usually caused by a yeast called Candida albicans. Another name for vaginal thrush is candidiasis. It can usually be treated with medications from your GP or the pharmacy. Up to three-quarters of women will have thrush at least once in their lives. Around 1 in 20 women have recurrent infections with vaginal thrush.
Symptoms of vaginal thrush
Symptoms associated with vaginal thrush, include:
- genital itch – this is the most common symptom of thrush, especially if worse before your period
- soreness or burning of the vagina during or after sex
- abnormal discharge – usually thick and white or creamy coloured, sometimes described as looking like cottage cheese
- vaginal discharge from thrush does not usually smell
- redness and inflammation of the vulva
- soreness or discomfort such as stinging, on urination
- pain – particularly if thrush is recurrent and inappropriately managed
- small white spots on the vaginal wall.
Symptoms of vaginal thrush may last for hours, days, weeks or even months. They may often happen in the second half of the menstrual cycle (before your period), due to there being more progesterone. Having sex may worsen symptoms of thrush.
Causes of vaginal thrush
Vaginal thrush is caused by yeasts called Candida. In 95 per cent of cases, Candida albicans is the cause, but occasionally other Candida species, such as Candida glabrata seem to be the cause.
Note that some women can have Candida yeasts colonising their vaginas without causing any problems. They may test positive for Candida on a swab, but not have any symptoms. These women don’t require any treatment.
Higher oestrogen levels are thought to make women more prone to vaginal thrush. Younger women and also post-menopausal women suffer less often from vaginal thrush, due to a lack of oestrogen. But this doesn’t apply to post-menopausal women using topical or oral oestrogen as hormone replacement therapy.
There are some factors that make a woman more likely to develop vaginal thrush, including:
- having diabetes
- having recently taken antibiotics
- using higher dose combined oral contraceptives which have more oestrogen.
- chemotherapy (sometimes known as ‘chemo thrush’)
- immunodeficiency, e.g. HIV infection
- wearing wet or sweaty tight garments, such as swimmers.
Some women are prone to having recurrent episodes of thrush. There are also women who have continuous symptoms of vaginal thrush, thought to be due to them being sensitive to yeasts that exist as part of their normal vaginal flora.
Tests and diagnosis of vaginal thrush
A diagnosis of vaginal thrush is often made based on your symptoms. However, there are many other conditions of the vagina and vulva that have symptoms in common with thrush, so if there is the slightest doubt about the diagnosis, it is essential that your doctor takes a vaginal swab and sends it for analysis before treatment is started.
Note that vaginal swabs may not always test positive for Candida, even when a woman has significant symptoms.
When should you seek medical advice?
You should see your doctor if:
- this is the first time you have experienced thrush symptoms
- you are not sure if the problem you have is thrush
- this is the second thrush infection you have had in less than a year
- you are pregnant or breast feeding
- you have not responded to treatment
- you start to feel unwell.
If recurrence of symptoms occurs in less than a year, or your response to treatment is unsatisfactory, do not self-treat or you risk producing a chronic (ongoing) condition. When you see your doctor, make sure that the diagnosis is confirmed with a swab sent to a pathology lab. Please note that swabs may not give any useful results if any treatment has been used in the preceding weeks.
What type of doctors look after women with vaginal thrush?
Your General Practitioner is a good place to start if you think you have vaginal thrush. For very problematic infections, there are specialists in gynaecological dermatology or female genital dermatology who have experience in managing vulval disorders, including chronic or recurrent vaginal thrush. Your GP should be able to refer you to a specialist, if necessary, or you can also search online for ‘vulval clinics’.
Treatment of vaginal thrush
The treatment for vaginal thrush involves a cream from the anti-candidal group of medicines called azoles, inserted into the vagina at night. This is the most effective means of eradicating the yeast from the vagina.
These azole creams usually come with an applicator and include clotrimazole (e.g. Canesten). Even if your period starts you can still use these creams. The creams are available from pharmacies.
If it is an isolated episode of thrush (that’s one that occurs more than a year since the previous episode) you may need only one dose of the azole cream into your vagina at night. There are also 3-day and 6-day treatment options.
If the thrush is not caused by Candida albicans, but by another species such as Candida glabrata, then treatment will usually be different. This is because infections caused by non-Candida albicans species may be resistant to the azole creams.
Treatment of recurrent vaginal thrush
A minority of women will get thrush a couple of times a year or more. More than 4 episodes in 12 months is known as recurrent candidiasis or recurrent thrush and is best managed by a doctor with a special interest in the area. This does not necessarily have to be a specialist – many GPs have a special interest in women’s health issues and are very knowledgeable about this condition.
If you have recurrent vaginal thrush you should never self-treat. Your doctor should take a vaginal swab with each episode of thrush to monitor your condition. Treatment options for recurrent thrush include:
- combined oral and vaginal azole therapy – this means using intra-vaginal anti-candidal creams (e.g. clotrimazole cream such as Canesten) and taking tablets (e.g. fluconazole capsules such as Canesoral or Diflucan)
- long-term (at least 6 months’) treatment with an oral azole – tablets or capsules such as Diflucan (fluconazole) or Sporanox (itraconazole)
- a change of contraception to Depo Provera (preferably for thrush) or Implanon NXT
- a change to a lower oestrogen dose for women taking hormone replacement therapy (HRT).
Sometimes, if the area is very sore, your doctor may advise you to use a 1% hydrocortisone cream for a specified short length of time.
Some anti-fungal vaginal creams may damage latex condoms or contraceptive devices, such as diaphragms or cervical caps.
Treatment of chronic vaginal thrush
Chronic vaginal thrush is different to recurrent thrush. It causes continuous (chronic) symptoms and is thought to be due to the body being sensitive to yeasts that live normally in the vagina. Vaginal swabs may be positive or negative for the yeasts at different times. A woman can have strong symptoms but still have a negative swab result.
Treatment for chronic vaginal thrush (unless you are pregnant) involves oral azole medicines, such as fluconazole (e.g. Canesoral, Diflucan) or itraconazole (e.g. Sporanox) capsules or tablets. These are not to be taken by pregnant women.
How long will it take vaginal thrush to go?
Usually, you can expect to get some relief from symptoms any time from a few hours to a few days. If you are not getting any relief of symptoms in a few days, contact your doctor. It may take a week to clear up the thrush infection. Recurrent thrush or severe infections may take longer. Chronic thrush symptoms may take between 2 weeks and 6 months to go.
If a vaginal thrush infection is not treated, it will probably get worse and the inflamed area may become cracked and be vulnerable to a secondary infection.
Prevention of vaginal thrush
Numerous lifestyle changes have been suggested to prevent thrush. These include avoiding sugar and other dietary measures, avoidance of tight clothing, and alteration of sexual practices. None of these have been proven to be effective. Candida albicans is not sexually transmitted.
Antibiotics promote the growth of yeasts, so are best avoided unless necessary.
Contrary to popular belief, the oral contraceptive pill makes no significant difference to a woman’s chances of getting thrush. The long-acting progestogen contraceptives, Depo-Provera (injection) and Implanon NXT (implant), however, do lower the incidence of thrush, because they suppress ovarian production of oestrogen and contain no oestrogen themselves. Breast feeding has the same effect which is why thrush is seldom a problem in breast feeding women.
What can I do to help avoid thrush?
There are some things you can do to reduce your risk of getting thrush, such as:
- don’t use soap, shampoo, deodorants or talcum powder in your genital area
- wear loose cotton underwear
- don’t use vaginal douches
- avoid bath salts and foams
- dry your genital area well after baths, showers and swimming
- wipe from front to back after using the toilet.
There are some widely touted home remedies which have NOT been shown to help, including:
- putting yoghurt into the vagina
- low-sugar diets
- taking probiotics.
How do you get vaginal thrush?
The yeast that causes most cases of thrush, Candida albicans, enters the body via the food you eat. It can live naturally in the bowel without causing any problems. It is spread to the vagina from the anus via the perineum – the area between the anus and the vagina. This is known as perineal spread. Other species of yeast often colonise the vagina but cause no harm.
Women are prone to vaginal thrush between puberty and the menopause because, under the influence of the hormone oestrogen, the cells lining the vagina produce a sugar and yeasts (which is what Candida albicans is) are attracted to sugars. That is why thrush is rare before puberty, in breast-feeding women (who are oestrogen deficient), and after the menopause, unless a woman is on hormone replacement therapy (HRT) or has diabetes.
Is vaginal thrush an STI?
Thrush is not a sexually transmitted infection (STI). Generally, no benefit is shown by treating the male sexual partner of women with recurrent vaginal thrush. Only in specific circumstances (e.g. balanitis) where swabs have been taken and Candida albicans confirmed, is treatment recommended for men.
Can a man catch thrush from a woman partner?
Some men may develop itching after sex, when their partner has thrush. This irritation is caused by secretions from the yeast in their partner’s vagina, but does not necessarily mean that the man has caught the Candida infection. Once the woman has treated and cleared the thrush infection, the man’s itch will go away. If the itch is troublesome, the man can ease the symptoms by using a combined hydrocortisone + anti-fungal cream for a couple of days.