Vaginal Thrush

• Have had a previous sexually transmitted infection (or your partner has).
• Have had a previous bad reaction to anti-thrush medication or treatments.
• Have a weakened immune system – for example, if you are on chemotherapy treatment for cancer or are taking long-term steroid medication for whatever reason.

And if you do treat yourself, see a doctor or nurse if the symptoms do not clear after treatment.

What can I do to prevent vaginal thrush returning (recurring)?

The following tips may help. However, they have not been proven to work by research. Their use is based on common practice rather than research studies:

• Hygiene. Thrush is not due to poor hygiene. However, the normal conditions of the vagina may be altered by excess washing and rinsing out (douching) of the vagina, bubble baths, scented soaps, spermicides, etc. The normal mucus and germs (bacteria) in the vagina may be upset by these things and allow Candida spp. to infect. Therefore, it may be best to wash just with water and unscented soap, and not to douche the vagina.
• Clothes. Don’t wear nylon underwear or tight-fitting jeans too often. Loose cotton pants are best. Stockings rather than tights are preferable. The aim is to prevent the vaginal area from being constantly warm, moist, and airless.

Antibiotic medicines. Be aware that thrush is more likely if you take antibiotics for other conditions. Antibiotics may kill the normal harmless bacteria in the vagina which help to defend against Candida spp. As Candida spp. are yeasts and not bacteria, they will not be killed by antibiotics. This is not to say that every course of antibiotics will lead to •  thrush. But, if you are prone to this problem and you are prescribed antibiotics then have some anti-thrush treatment ready to use at the first sign of thrush.

• Sex. Thrush is not a sexually transmitted disease. However, friction when you have sex may cause minor damage to the vagina which may make Candida spp. more likely to thrive. So, make sure your vagina is well lubricated when having sex. If natural secretions are not sufficient then use a lubricant when you have sex.

What is the treatment for repeated (recurrent) vaginal thrush?

If you have recurrent bouts of thrush, then one option is simply to treat each bout as and when it occurs. Another option that your doctor may suggest is as follows:

• Use one of the treatments described above (topical treatments or tablets) – but for longer than usual. Your doctor will advise exactly how long to use the treatment for. For example, this may be for 7-14 days for topical treatments.
• Then use a topical treatment or take a fluconazole tablet once per week. (Sometimes other tablets may be prescribed; follow the instructions given by your doctor.) This is called maintenance treatment, which often prevents thrush from recurring.
• Continue maintenance treatment for six months and then stop.
• Most women remain clear of thrush during maintenance treatment. After treatment is stopped, many of those treated remain free of thrush, or only develop the occasional bout again. However, some women return to developing recurrent thrush. In such cases, if necessary, the treatment plan can be repeated, and maintenance treatment continued for longer.
• See your doctor if you develop thrush whilst on maintenance treatment. This may indicate that you have a resistant strain of Candida spp. Which may require an alternative treatment.
• If you have recurrent thrush, your doctor or nurse may also discuss your current method of contraception with you and suggest a change. There has been talk in the past about the combined oral contraceptive pill (the pill that contains both oestrogen and progesterone hormones) possibly making recurrent thrush more likely. However, the evidence around this is a little contradictory. One study has shown that woman who use the progestogen-only contraceptive injection may be less likely to develop thrush.

Some other points about vaginal thrush

• ‘Natural’ remedies for thrush include: live yoghurt inserted into the vagina or adding vinegar or bicarbonate of soda to a bath to alter the acidity of the vagina. At present there is little scientific evidence to show that these remedies work but some women may find that they help soothe their symptoms.
• Thrush is not a sexually transmitted infection. Candida spp. are yeast germs (bacteria) which commonly occur on the skin and vagina. For reasons not quite clear, they sometimes multiply 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. If you are pregnant, a course of seven days of topical treatment is usually advised to clear thrush.