Recurrent Vaginal Thrush

What is thrush?

  • Firstly, very common! 3 out of 4 women will have it at least once in their lives.
  • The formal name is vulvovaginal candidiasis, it’s caused by an overgrowth of Candida, a yeast (fungus).
  • You know the gut microbiome? Well your vagina has one to! Thrush happens when the balance of micoorganisms in your vagina goes awry, one of the reasons antibiotics can predispose you to thrush.
  • It’s NOT an STI – however you can pass it to your partner and back again if having sex with the same person repeatedly.
  • Symptoms:
    • Sore vulva – this can make it painful to pass urine or painful when having sex.
    • Itchy vulva
    • Vaginal discharge, classically referred to as “cottage cheese” in appearance; creamy white and can be quite thick. It usually doesn’t smell. bowl-3366480_1920

You can buy treatment at  the pharmacy – but if this doesn’t work go to see your GP – they will likely examine you and take a swab, just to check you actually have thrush and not something else that needs a different treatment. If you haven’t had thrush before, it’s different to usual or you’re just unsure, you can always go to your GP too.

What is recurrent thrush?

  • More than 4 episodes in a year, with at least partial resolution of symptoms between episodes

Risk factors for thrush:

  • Diabetes
  • Pregnancy
  • Recurrent courses of antibiotics
  • Having sex with your partner before thrush is treated and passing it back and forth between you.
  • Cyclical changes – hormonal changes during the menstrual cycle can change the pH levels in your vagina slightly, this can predispose you to thrush.
    • Along with natural cyclical changes there is a thought that taking HRT or the combined pill can predispose you to recurrent thrush – more evidence is needed though, as it is unclear as yet if this is the case.
  • Douching or other excessive washing – again, disrupts that sensitive microbiome balance.  bath-465577_1920.jpg
  • Stress – stress can weaken the immune system, predisposing you to infection.
  • Being immunocompromised – such as taking immunomodulating agents, chemotherapy or corticosteroids.

Treatment of recurrent thrush:

There are a few options if you suffer from recurrent thrush.

Standard treatment:

  1. You can treat each round of infection when they occur.
  2. Have a longer treatment with antifungals.
  3. Have maintenance treatment – this is to try and prevent thrush from recurring. This would usually be a topical treatment or oral antifungal once a week for 6 months.
    • Most women don’t have thrush whilst on maintenance treatment, the frequency of infections once the treatment has stopped is variable.

Probiotic yoghurt!

Yes, this is actually mentioned in NICE guidelines 1! NICE recommends advising woman to consider using probiotics because although there is no evidence that they are effective, there is no evidence of (or concerns about) serious adverse effects. Whilst you can eat it, it’s best applied topicially, i.e. spread the yoghurt where you have the infection, vulvally or vaginally!

raspberry-1293616_1920.jpg

The authors of a review 2 advised it is important to consider:

  • Applying yoghurt to the vagina could be embarrassing or uncomfortable.
  • Compositions of yoghurt can vary, and thus the effects differ.
    • Personally, I’d say stick to natural yoghurt, not flavoured!
  • The alteration in vaginal pH that comes with intravaginal yoghurt is unknown.

A potentially less messy way to go about things, a Cochrane review discovered that using probiotics in combination with antifungals can reduce the risk of recurrent infection at one month, but not necessarily long term 3.

Canesflor is a probiotic pessary developed by Canesten. It is contains the species Lactobacillus plantarum P 17630, chosen for this product due to its ability to stick to the vaginal mucosa.it helps to restore the natural ecosystem of your vagina, helping to prevent thrush.

Preventing thrush:

  • If you are diabetic, good glycaemic control will reduce the risk of recurrent thrush.
  • If you use the combined oral contraceptive pill and suffer with recurrent thrush, you could consider alternative contraception, yet as mentioned above, the evidence surrounding the link between this and recurrent thrush is unclear at present.
  • Don’t douch
  • Avoid perfumed/scented bubble baths and soaps – use emollient in the bath as a soap substitute or just use water.
  • Wear loose clothing, avoid wearing tights if possible.
  • Use non-bio washing powder for your delicates.
  • Only take antibiotics when necessary
  • Ensure your thrush has been treated before having sex. This is to prevent you and your partner passing it back and forth to eachother.
    • You can also use lubricants whilst having sex to prevent minor damage to the vagina which can predispose you to infection.
  • Keep stress as low as possible – easier said than done I know, things like yoga, meditation, access to nature, prioritising “me time” can help.  beach-1838339_1920.jpg

If you have any questions or are unsure of if your symptoms are indeed caused by thrush, or over the counter treatments don’t seem to be working go back and see your GP.

I hope this helps,

Emma x

References:

  1. NICE. Candida – female genital. (2017). Available at: https://cks.nice.org.uk/candida-female-genital#!scenario:2.
  2. Lopez, J. E. M. Candidiasis (vulvovaginal). BMJ Clin. Evid. 2015, (2015).
  3. Xie, H. Y. et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst. Rev. 11, CD010496 (2017).

 

 

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