Thrush (candida albicans)

Thrush is caused by a yeast that normally lives harmlessly on the skin, or in the mouth, gut and vagina without causing any problems. Normally it is kept in check by harmless bacteria. Occasionally conditions change and the yeast increases rapidly, causing symptoms. This is called clinical thrush or candidiasis.

Signs and symptoms
Both men and women can get thrush.
Women - There may be one or more symptoms, including: itching, soreness and redness around the vagina, vulva or anus a thick, white discharge from the vagina that looks like cottage cheese and smells yeasty, a swollen vulva, pain when you have sex, pain when you pass urine.
Men - There may be one or more symptoms, including: irritation, burning or itching under the foreskin or on the tip of the penis, a redness or red patches under the foreskin or on the tip of the penis, a thick cheesy discharge under the foreskin, difficulty in pulling back the foreskin, a slight discharge from the urethra, discomfort when you pass urine.

How thrush develops
Your chances of developing thrush are increased if you: are pregnant, wear lycra shorts or tight nylon clothes, take certain antibiotics, use too much vaginal deodorant or perfumed bubble bath (causing irritation), have sex with someone who has a thrush infection.

Women
Do not assume a vaginal discharge is thrush. If you have never had thrush before, then see a doctor or nurse for advice on treatment. A doctor or nurse may examine you. No tests may be necessary if the symptoms and signs are typical. However, the doctor or nurse may take a small sample of the discharge with a swab if the cause of the discharge is not clear. This is sent to the lab to confirm the cause of infection. If you have had thrush in the past and the same symptoms recur, then it is common practice to treat it without an examination or tests. Many women know when they have thrush and treat it themselves. However, see a doctor or nurse if symptoms are different to what you expect, of if the symptoms do not clear with treatment.

What are the treatment options for thrush?
Topical treatments for women - there are various pessaries and creams which you insert into the vagina with an applicator. They contain anti-yeast medicines such as clotrimazole, econazole, fenticonazole, or miconazole. Commonly, a single large dose inserted into the vagina is sufficient to clear a bout of thrush. However, you may also want to rub some anti-yeast cream onto the skin around the vagina for a few days, especially if it is itchy. You can get topical treatments on prescription, or you can buy them at pharmacies. Side-effects are uncommon, but read the product label for full information.

Tablets. Two options are available. Fluconazole, which is taken as a single dose, or Itraconazole which is taken as two doses over the course of one day. You can get these treatments on prescription, and you can also buy Fluconazole from pharmacies without a prescription. Side-effects are uncommon, but always read the product label for full information. Women should not take these if they are pregnant or breastfeeding.

What if treatment does not work?
If you still have symptoms after a week from starting treatment, see your doctor or nurse. Treatment does not clear symptoms in up to 1 in 5 cases. Reasons why treatment may fail include:

• The symptoms may not be due to thrush. There are other causes of a vaginal discharge. Also, thrush can occur at the same time as another infection. You may need tests such as a vaginal swab to clarify the cause of the discharge or other symptoms.
  
• Most bouts of thrush are caused by Candida albicans. However, about 1 in 10 bouts of thrush are caused by other strains of Candida such as Candida glabrata. These may not be so easily treated with the usual anti-yeast medicines.
  
• You may not have used the treatment correctly
  
• You may have had a quick recurrence of a new thrush infection. This is more likely if you are taking antibiotics, or if you have undiagnosed or poorly controlled diabetes.
  

Some other points about thrush

• Natural remedies for thrush include: live yoghurt inserted into the vagina; adding vinegar or bicarbonate of soda to a bath to alter the acidity of the vagina; tampons impregnated with tea tree oil. However, there is little scientific evidence that these remedies are effective.
  
• Thrush is not a sexually transmitted infection. Candida is a germ which commonly occurs on the skin and vagina. For reasons not quite clear, it sometimes multiplies to cause symptoms.
  
• Male sexual partners do not need treatment unless they have symptoms of thrush on their penis. Symptoms in men include redness, itch, and soreness of the foreskin and the head (glans) of the penis. Women do not catch thrush from men who have no symptoms.
  
• Thrush occurs more commonly in pregnant women, and can be more difficult to clear. It can take several days of topical treatment to clear thrush if you are pregnant.
  
• Some women develop recurring thrush. This is defined as four or more times a year. If this occurs, see your doctor for advice on preventative treatment.
• You should get individual advice about having sex during treatment from your doctor, or nurse.
• Any man can develop thrush, but it is more likely in uncircumcised men, who should wash under their foreskins as part of their daily routine.

Follow-up
Your doctor or nurse may advise you to return for a check-up after you have completed the treatment to make sure that the thrush is gone.

Complications
The symptoms of thrush may go away without treatment but it can get very sore. Sometimes men get an uncomfortable swelling of the foreskin, but complications are rare. Remember, after treatment, using condoms during sex can reduce your risk of getting or passing on sexually transmitted infections.

Source: Adapted with permission from a © document supplied by EMIS and PIP, and Health Education Authority