Medical Advice

Chronic Thrush (also known as Candida)

Thrush is a type of fungus that is found in the human body, particularly the vagina, mouth and inside your intestines. It is a very common problem. About 70% of women will have an attack at least once in their life. The cost of treating thrush is enormous and in the USA it has been estimated to be about a billion dollars a year.

Single acute attacks of thrush happen now and then to most of us. Your vagina suddenly feels sore and itchy, with a heavy yellow to white discharge. If you have a look your vagina will be bright red, with white cheesy material inside. These attacks get better quickly as soon as you use an antifungal pessary or oral capsule that you can buy over the counter from the chemist.

Thrush can be diagnosed by a test called a vaginal swab. A cotton bud is inserted just a couple of centimetres into the vagina. It is then sent to the lab where it undergoes a test called a “culture”. This means that the fungus can grow, just like a mould on a piece of bread. The fungus can then be identified. Most of them will be reported to be a fungus called Candida Albicans, however other types of Candida occur as well, and they can sometimes cause the same symptoms.

If you were to take one of these cultures from 100 random women, it is likely that 20% of them would have a positive culture. This means that it is a very common thing to find thrush in the vagina. Despite this only a few women have problems with lots of attacks of thrush.

An even smaller percentage of women have symptoms of thrush all the time. They complain of a number of different symptoms. These include constant itch, pain and burning feelings when they have sex, swelling and soreness. It is common for these symptoms to cycle, being most severe in the week before their period, suddenly improving on the first day of their period. Their vagina and the skin around the vaginal opening is often very red and irritable. Often the skin is split and this makes it very tender and sore. Discharge can occur although it isn’t as thick and white as it is when patients have a single acute attack of thrush. These women find that antifungal creams and capsules work: but only for a short time.

Many women find that antibiotics are always followed by an attack of thrush. Some say their partner might be itchy after sex or have a rash on his penis.

Most women with chronic thrush are perfectly healthy in every other way. They don’t have anything at all wrong with their immune systems and there is rarely any need to do a lot of tests on their immunity.

We think that the reason women with chronic thrush get all these symptoms is not because their immunity to thrush is low, but in fact too high. Their bodies try so hard to fight off the fungus that the result is almost like an allergic reaction in their vagina, causing all of these symptoms. But exactly how this happens is not known.

TREATMENT

There have been many studies done by the medical profession to find out the best way to treat chronic thrush. There is no single way to do it, but this is what seems to work best:

Treatment should be started with a daily dose of an antifungal medicine. This can be in the form of a capsule that is taken by mouth every day or a pessary that is inserted into the vagina. Because treatment has to go on for a long time, most patients prefer to take something by mouth. The treatment has to continue until you are completely better. This often takes three to six months. At this point, the dose is gradually reduced to the lowest level that will control your symptoms over the next 6 months. This varies from patient to patient and some are not able to reduce their medication at all.

All of the studies done have shown that about 50% of patients are then able to stop their treatment and remain well. However this means that the other 50% need to keep going with some level of treatment (what we call maintenance treatment). This also varies a lot and for some it is a lot less than others.

Reducing heat, sweat and friction, avoiding antibiotics unless they are really needed and losing weight if you are too heavy are just some of the other things you should consider.

Estrogen (female hormone) is important for Candida to flourish in the vagina. This means girls who haven’t reached puberty and women after menopause don’t get thrush. Despite this, the oral contraceptive pill usually makes no difference and you don’t have to stop or change it. Intrauterine devices such as Mirena® can very occasionally be the cause of thrush and if you think you developed thrush after having one inserted, it could be worthwhile having it taken out.

The one bit of good news is that as women who suffer from thrush get older, they usually improve. During pregnancy they may also improve as well and they are usually fine when they are breastfeeding. Although this condition can happen at any age, it is most common in teens and women in their 20’s. Once you reach menopause it goes away, but take care about hormone replacement therapy if you have been prone to thrush. It may bring it back!

What about diet and probiotics?

The anti-candida diet is a popular way of trying to control thrush. Some patients swear by it, but the truth is that it doesn’t hold up to scrutiny by scientists and it’s very hard to stick to. The same is true about Probiotics and yoghurt. None of these things have been conclusively shown to improve thrush.

However, if you are attracted to naturopathic treatments, these measures are harmless and if they help you, that’s great.

What can I do right now?

If after reading this, you think you may have chronic thrush, don’t do a thing yourself other than follow a good vulval skin care regime.

Don’t rush down to the chemist to buy an antifungal treatment. Go to your doctor and have a vaginal swab. It won’t hurt, will be inexpensive and has a good chance of proving what your problem is. If you use antifungal medicines BEFORE going to the doctor, the swab will be negative and then it will be much harder for your doctor to make a diagnosis.

Make sure your doctor understands that your condition is not a “one-off” but has been going on for some time. If your doctor is not sure how to handle this situation, direct him or her to this website! You will need prolonged treatment: this is your best chance of going back to a normal you, not worried about being itchy and sore and able to have intercourse without pain.