Pregnancy Bliss | Reproductive Health Answers
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.
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:
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.
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.
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.
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.
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:
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.
The merit of treating the sexual partner appears to be doubtful. Thrush is not a sexually transmitted disease.
Last update: May 26, 2012