Three out of four women will experience thrush at some point in their lives. It is uncomfortable, itchy and can cause considerable worry. So what is it, and how can you avoid or treat it?
Thrush is the lay term for a yeast infection of the vulva and vagina (the genital area for women). Men can also get thrush, but it is much less common and causes fewer symptoms. The yeast responsible for the majority of thrush is called Candida Albicans (CA). About a third of young women will have a small amount of CA present in their vagina all the time – this doesn’t cause any symptoms and doesn’t require any treatment. However, if there is an “overgrowth” of CA, symptomatic thrush can develop.
Thrush is not a sexually transmitted disease, and although it can be bothersome, it is not at all dangerous. Sex can trigger it as the friction in the genital area can make the skin vulnerable to infection. Other factors that can lead to thrush include:
* Age – thrush can occur at any age, but is more common when oestrogen levels are high (during menstrual years)
* Contraceptive pills, especially higher-dose combined contraceptives
* Diabetes – sometimes recurrent thrush can be the only sign pointing to underlying diabetes
* Immunosuppression – lowered immunity, either as a result of illness (such as HIV or cancer), or medication (such as immunosuppressants or chemotherapy), can lead to recurrent thrush that is often very hard to treat
* Frequent washing of the genital area – especially douching, or using perfumed products; the best way to clean your genital area is actually to use plain water and ensure you dry thoroughly afterwards
* Iron deficiency – lack of iron makes thrush more likely, and taking iron supplements can be a successful adjunct to treatment for some women
* Pregnancy – the risk of thrush is much higher during pregnancy – luckily this carries no risk at all to the baby
* Antibiotics – some antibiotics, especially broad-spectrum ones such as augmentin, increase the likelihood of getting thrush; for women who are especially prone to this, taking preventative treatment (eg antifungal cream) at the same time as the antibiotics can be a great option.
Symptoms of thrush are usually pretty typical:
* Itching, soreness and a burning irritation of the genital area
* White discharge (different in appearance from the normal discharge associated with menstrual cycles)
* A red rash affecting the external genital area, and sometimes extending around the groin, anus and upper thighs.
Thrush can last for a few hours or days, and unfortunately for some women can be a recurring problem, especially around the time of their period.
If you are concerned you might have thrush, especially if you haven’t had it before, it is worth seeing your doctor or sexual health clinic to get an accurate diagnosis. They will do swabs from the genital area, and check you don’t have any other cause for your symptoms. They may also suggest you get testing for an underlying condition, such as diabetes, especially if your symptoms are prolonged, severe or recurrent.
Treatment is usually simple and effective. Antifungals are available in creams, pessaries and oral tablets. The jury is out as to which is the most effective, but many women have a preference or know what works best for them. Some are single-dose courses, while others (eg the creams) need to be used for several days. The creams are completely safe to use in pregnancy, but tablets should be avoided. Most treatments are available over the counter at the pharmacy.
If your symptoms don’t resolve with treatment, it is really important to find out why. Either you don’t have thrush but have some other condition requiring different treatment, or your thrush is particularly resistant to medication.
Women or men who experience recurrent or persistent thrush can really struggle with the ongoing discomfort and impact on their lives. Looking at longer term or different treatment options, a few months of oral medication to try and reduce the amount of CA present can be a really effective solution.
Avoiding triggers is important too – such as reducing the amount of irritant products you use in the bath and shower, only wearing cotton underwear, changing your contraceptive pill, or treating an underlying iron deficiency or skin condition. Unfortunately, there is no evidence that treating your partner makes any difference to your symptoms or your risk of recurrence.
There are lots of myths out there about “home remedies” for thrush – unfortunately there is little or no evidence that they actually work when compared with placebo treatment. Live yoghurt and sugar-free diets won’t hurt, but probably won’t be of much benefit either. The one “natural” remedy that might be of use is boric acid – inserting a boron pessary at night into the vagina is thought to alter the pH and reduce the presence of yeasts.