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Vaginal Discharge: Thrush

Author: 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:

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 dischargevaginal 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:

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:

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: May 26, 2012

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

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