Pregnancy Bliss | Reproductive Health Answers
Vaginal Discharge: Thrush
By Dr J Kabyemela, MD
This is a very common problem, presenting in varying degrees of severity from person to person. Not every ‘discharge’ is abnormal in the strict sense of the term and certainly many, probably most, cases of vaginal discharge are nothing to do with a sexually transmitted infection of any kind. Now that we have cleared that up, let’s look at the various types of vaginal discharge.
Understanding vaginal thrush (candidiasis)
Thrush is caused by a fungal organism or yeast called Candida albicans. Other Candida types such as Candida glabrata are also sometimes found to be the cause. These fungal organisms are very similar and treatment is the same. Thrush is also known as candidiasis, a name derived from the causative organism.
About 1 in 20 women experience recurrent vaginal thrush. This means, they will report 4 or more episodes of this type of vaginal discharge every year. This is despite using apparently effective treatment.
Why Vaginal Thrush:
The majority of women plagued by recurrent vaginal thrush have no identifiable risk factor. Known predisposing factors for vaginal thrush include:
v Diabetes
v Immunosuppression such as for those on chemotherapy or long-term steroids
v Chronic iron deficiency
v Prolonged use of antibiotics
v Pregnancy
v Under-active thyroid (hypothyroidism)
v Insufficiency of the adrenal gland (Addison’s disease)
v Combined contraceptive pill
I need to reiterate again that the majority of women with recurrent vaginal thrush will have none of these recognised risk factors.
Vaginal thrush: How
So, how does vaginal thrush look like: The more appropriate descriptive term is vulvo-vaginal thrush (vulvo-vaginal candidiasis). This is because, apart from the vaginal canal, the external genitalia (vulva) is also affected.
The typical thrush discharge
is thick white (or off-white) and tends to coat the
vagina, cervix and can be seen on the vulva or staining the underwear. There may
be no pain or discomfort but occasionally there are inflammatory changes with resulting
vulval soreness. Some women report soreness during sexual intercourse but this is
not a common feature of thrush. Occasionally there may be a stinging sensation on
passing urine. There is no foul smell. In a few instances, the discharge may be watery
rather than thick. This is uncommon.
Diagnosis of Thrush (vulvo-vaginal candidiasis)
A woman affected by vulvo-vaginal candidiasis (thrush) can accurately suspect it. This is because the discharge tends to be fairly different from other types of vaginal discharges. The thick, sometimes curd-like consistency, whitish colour, absence of odour and pain will usually clinch the diagnosis. However, if it is appearing for the first time, it is prudent to see a doctor for proper microbiology studies. This will also allow for assessment of possible predisposing factors.
A vaginal swab allows the sample to be examined under the microscope in the laboratory and the diagnosis is confirmed that way.
Treatment for Thrush
This common condition can be treated quite effectively by both oral and vaginal medication. You need to use one or the other and not both. Both forms of treatment are usually quite effective.
A one off episode of thrush is usually treated successfully using a single dose or a short course of an anti-fungal preparation.
Options are:
v Vaginal Clotrimazole 500 mg pessary (suppository) once.
v Vaginal Clotrimazole 200 mg pessary (suppository) daily for 3 days.
v Vaginal Clotrimazole 200 mg pessary (suppository) inserted every 3rd day for a total of three doses (Day 1, Day 4 and Day 7)
v Oral Fluconazole 150 or 200 mg tablet once
v Oral Fluconazole 150 or 200 mg every 3rd day for a total of three doses (Day 1, Day 4 and Day 7)
For one-off episodes of vulvo-vaginal thrush (as opposed to recurrent thrush), there is no evidence that the three-dose course is significantly superior to a one off dose. However, it is deemed prudent to adopt that approach where there is an identifiable risk factor such as immunosuppression or diabetes.
Where there are local inflammatory changes including redness, soreness and pain, the treatment needs to be more aggressive, taken daily and lasting at least a week.
Whilst local treatment (vaginal suppositories or cream) can be used during pregnancy, oral medication is to be avoided during this time.
Yogurt for Thrush
It is a generally held belief that so-called ‘live yogurt’ can cure thrush. There is enthusiasm for this on the basis that it is a ‘natural remedy’, therefore allowing the person to avoid using medication. The theory is based on the fact that live yogurt contains the bacteria Lactobacillus acidophilus. By putting a spoonful of the stuff into the vagina, the theory goes, this harmless bacteria will flourish displacing and eventually eliminating the yeast Candida that causes thrush. Unfortunately, this attractive theory does not stand up to scientific scrutiny. A study carried out in Australia and published in the British Medical Journal in August 2004 conclusively showed that, in fact, this strategy does not work.
Treating recurrent Thrush
Many women affected by vaginal thrush would have the experience of successfully treating it only to see it come back a few weeks or months later. When there is a history of four or more episodes within 12 months, this has got to be treated as recurrent thrush and managed accordingly.
Recurrent thrush calls for maintenance treatment lasting several months. This is almost always successful in keeping the person free of the problem. However, even with this prolonged treatment, up to 50% of women will experience recurrence of the problem within months of stopping the maintenance course.
Options for recurrent thrush are:
v Clotrimazole 500 mg pessary (suppository) inserted vaginally every week for 6 months.
v Fluconazole tablet 150 or 200 mg taken orally weekly for 6 months
v Itraconazole 400 mg taken orally monthly for 6 months. The monthly dose is taken on one day but divided in two as 200 mg twice.
v Clotrimazole vaginal cream 200 mg twice weekly for 6 months.
Thrush resistance to medication
This problem is virtually unknown. The Candida yeast responds to treatment every time. The problem is its propensity to come back even after a successful elimination.
Thrush: Treating sexual partners
The merit of treating the sexual partner appears to be doubtful. Thrush is not a sexually transmitted disease.
Next Page: Bacterial vaginosis
Last update: March 17, 2011
A creamy vaginal discharge is unlikely to be thrush. This type of discharge can be persistent , usually has no underlying pathology and will therefore not respond to attempted treatment