Vaginal Thrush (candida)

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Vaginal candida - Candidiasis - Thrush - is one of the more common vaginal infections.

There are a number of microorganisms that may cause vaginal infection and several may co-exist.

• Candida.

These are yeast organisms that are found in the vagina in 25% of women usually without any symptoms. The most common species of candida to be found in the vagina is Candida albicans which is an organism that lives in the bowel and can easily be transferred from back to front passage. Symptoms occur when there is an excess of the yeast. High blood sugar levels (diabetes mellitus), pregnancy, antibiotics and steroid administration tend to increase the incidence of candidiasis. An acidic environment encourages the growth of the candida.  

Symptoms of vaginal candida.             

Typically, acute candida vaginitis (inflammation of the vagina) is accompanied by symptoms of intense irritation and at times pain. vaginal candida is colloquially known as thrush. The discharge is thick and white (described as milk curds). The skin of the vulva surrounding the vaginal entrance may be acutely red.

Picture of candida vulvovaginitis - vaginal thrush and vulval thrush infection. Note the typical picture appearance like milk-curds

Picture (photograph) of candida vulvovaginitis - vaginal thrush and vulval thrush infection.

Picture of vaginal discharge associated with candida.

 

 

Related Medical Abstracts - Click on the paper title:-

• Gynaecological and microbiological findings in women attending for a general health check-up (1998-01)

How are vaginal infections treated?

From a theoretical point of view, one should usually await the results of investigations before commencing treatment. In clinical practice one is keen to make an early start in assisting patients and it is common practice to commence treatment on the basis of clinical observations and adjust treatment subsequently according to investigation results.

Candida may respond to Nystatin (Nystan BMS) vaginal pessaries and cream. The full course of 14 days should be followed. Candida is sensitive to imidazole derivatives (Table 22.1), which are usually applied locally as creams or pessaries.

Table 22.1  Imidazoles used for the treatment of genital candida infections. 

 

 

The vaginal creams may be applied internally for vaginal infections and externally for vulval infections. The creams may also be applied to the penis of the partner particularly when there are recurrent infections.

There are four pessaries designed for single application. These are

• Canesten-1,
• Ecostatin-1,
• Gynokatarin-1 and
• Gyno-Pevaryl 1.

Three preparations are taken orally

• fluconazole (Diflucan 150 Pfizer),
• ketoconazole (Nizoral- Janssen-Cilag) and
• itraconazole (Sporanox- Janssen-Cilag). 

The vaginal creams may be applied internally for vaginal infections and externally for vulval infections. The creams may also be applied to the penis of the partner particularly when there are recurrent infections.

Related Medical Abstracts - Click on the paper title:-

• Itraconazole vs fluconazole for the treatment of uncomplicated acute vaginal and vulvovaginal candida in nonpregnant women: a metaanalysis of randomized controlled trials.(2008-01)

   

Recurrent vaginal thrush (vaginal candida). How can this be prevented?

About one per cent of women will have more than six episodes of vaginal candida a year.

Swab tests should be taken to confirm that you really are having bouts of thrush. Whilst most people have heard of thrush, relatively few know about bacterial vaginosis and this is more common than thrush.

It is prudent to exclude underlying illness and to correct other causes of vaginal discharge such as cervical ectropion (erosion cervical erosion).

Preventative measures include

• Avoiding clothes that keep the genital area moist.
• Natural fibres such as cotton are preferable to nylon.
• Underclothes should be thoroughly rinsed.
• Daily bathing/showering may be helpful
• but frequent vaginal douching should be avoided as this may remove protective organisms.
• Irritant soaps and bubble baths should be avoided.
• Shampoos should not be used in the bath.
• Use a soft clean towel and dab rather than rub.
• Rough flannels should not be used.
• Wiping the anal area from front to back may help to prevent transfer of candida to the vagina; soft toilet paper should be used.

One of the orally active agents may eliminate the reservoir of candida in the bowel although this may subsequently recur.

The objective is to prevent recurrence.

• As antibiotics may be associated with acute episodes, those particularly at risk should re quest treatment for candida at the same time.
• The male partner should be offered local or oral treatment.
• Some women will require regular preventative treatment usually administered after each period.
  
  

Related Medical Abstracts - Click on the paper title:-

• Causes of chronic vaginitis: analysis of a prospective database of affected women. (2006-01)
• Clinical aspects and luteal phase assessment in patients with recurrent vulvovaginal candida. (2006-02)
• Characterization of women with a history of recurrent vulvovaginal candidosis. (2002-01)
• The value of prophylactic (monthly) clotrimazole versus empiric self-treatment in recurrent vaginal candida (1994)
• Lack of in vitro resistance of Candida albicans to ketoconazole, itraconazole and clotrimazole in women treated for recurrent vaginal candida (1993)
• Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candida (1993)
• Intermittent prophylactic treatment of recurrent vaginal candida by postmenstrual application of a 500 mg clotrimazole vaginal tablet (1990)
• Zinc status in women with recurrent vulvovaginal candida (1986)

 

Does the combined oral contraceptive pill cause vaginal thrush (vaginal candida)?

The pill can probably be associated with, at most, a small increase in the incidence of candida.

Related Medical Abstracts - Click on the paper title:-

• Oral contraceptive use and vaginal candida colonization (1997)

• The impact of oral contraception on vulvovaginal candida. (1995)

Support Groups

Members of a support group, provide each other with various types of help and information for a particular shared difficulty.

The support may take the form of providing relevant information,

• relating personal experiences,
• listening to others' experiences,
• providing sympathetic understanding and
• establishing social networks.

A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy.

Support groups maintain interpersonal contact among their members in a variety of ways.

Support groups also maintain contact through printed information rich newsletters, telephone chains, internet forums, and mailing lists.

Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.

Evaluation of the quality of Web sites is discussed in (internet information). You may find that several general women's health sites may help you (internet information). The following are more specialised relevant Web sites:-

Candida (thrush):

• Www.fda.gov/fdac/features/396-yst.html
• Familydoctor.org/handouts/206.html
• Www. Msu.edu/user/eisthen/yeast/

Vaginal discharge:

• http://familydoctor.org/194.xml

• http://www. Mckinley.uiuc.edu/handouts/vaginal_discharge.html

  

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.