Thrush

What is this?

Thrush is very common. Candida albicans is the most common type of vaginal yeast which causes thrush. It is different to the yeasts in food.

Small numbers of yeasts in the vagina are normal and usually pose no problems - it is only when they overgrow that they may cause thrush symptoms.

How do you get it?

Thrush can occur for no obvious reason, but there are some things that make thrush more likely, including:

• antibiotics
• pregnancy
• diabetes
• sweaty and moist skin especially when there is friction (such as cycling or with sex)
• pre-existing skin conditions, such as eczema or psoriasis
• immunosuppressive medications

Thrush is not regarded as an STI, but sexual partners with a penis can sometimes get redness and irritation of the penis, especially after sex without using a condom.

What are the symptoms?

Symptoms can include:

• itchiness and discomfort on the vulva and vagina
• burning sensation and pain when passing urine and during sex
• thick white lumpy discharge which can be described as being similar to cottage cheese
• the area around the vulva and vagina may look red and swollen and there may be small skin cracks or splits

If you have any of these symptoms, you can usually treat yourself using over the counter products.

However, you should see your doctor if you:

• are not sure whether you have thrush
• have had several episodes of thrush
• have had recent sex without a condom with a new partner
• have pain in your pelvic area or abnormal bleeding
• have tried the thrush treatment and it didn't get better
• notice a change in shape, texture or colour of your vulva

Frequent thrush can be a sign of chronic vulval dermatitis.

How do you test for it?

Thrush is tested by taking a sample with a swab from the vagina and from splits on the vulva.

How is it treated?

Thrush is treated either with anti-fungal creams, pessaries or a single dose tablet: 

• Creams and pessaries can be purchased without a prescription at pharmacies. The treatments take from 1 to 7 days and are put inside the vagina with a special applicator.
• A single 150mg dose tablet (called Fluconazole) can also be purchased without a prescription at pharmacies. This tablet has similar effectiveness to creams and pessaries. It is more expensive and is not to be used in pregnancy. Single doses are rarely a problem with other medication, but you should discuss this with the pharmacist. Fluconazole is safe to use with the contraceptive pill. Sometimes a second dose is needed after a week, particularly if the symptoms are severe.

You may want to avoid having sex until after treatment as you may experience an uncomfortable burning sensation during or afterwards.

Repeated painful sex during thrush episodes can sometimes lead to ongoing pain even if the thrush is treated. The thrush creams can also weaken condoms, so apply the treatments after sex.

Are there any complications if not treated?

Thrush can be very uncomfortable, but it does not cause long term damage.

However, it can trigger ongoing vulval pain or chronic vaginal penetration pain if it is recurring and not treated, so getting treatment is strongly recommended.

Is it likely to come back after treatment?

Recurrent thrush

If you have four or more episodes of thrush a year, you may have recurrent thrush. This affects about 5% of females in the reproductive years. Symptoms do not go away completely after treatment and there may be skin splitting, or pain with or after intercourse.

This condition can be quite different to thrush, as discharge is not always present. People often report vaginal dryness and lack of lubrication with sexual activity. Often symptoms are worse before menstrual periods or only occur before periods.

Most people with recurrent thrush are healthy and do not have anything wrong with their immune system. It is not uncommon to have a previous history of hay fever, eczema or asthma. Their bodies are hypersensitive to candida albicans.

Treating recurrent thrush requires good basic skin care and long term anti-fungal medication. Medications suppress yeast growth and can be taken by mouth (Fluconazole) or in the vagina (cream or pessaries). The usual minimum length of treatment is about 6 months. Episodes can still occur after this but should be less frequent.

If you think you may be experiencing recurrent thrush, you should talk to your doctor.

How can I protect myself?

Avoid using soap, wet wipes, vaginal douches or cleansers sold as "feminine hygiene products", bubble bath or perfume in the vagina as this can disrupt the natural balance of vaginal yeast. 

If you get thrush after taking antibiotics, talk with your doctor about the need for the antibiotic and plan ahead to take thrush treatment at the first sign of thrush symptoms.

Where can I get help?

• Visit your local doctor
• Visit your local community health centre