| Candidiasis (Thrush)
What is thrush?
Thrush is an overgrowth of a yeast (fungus) called "candida." Candida
is normally found on the skin, in the stomach, colon, vagina, rectum,
mouth, and throat. Candida causes health problems only when there
is an overgrowth in one of these areas of the body. The medical
name for thrush is candidiasis.
Thrush is a common early symptom of HIV disease, usually occurring
in the mouth and/or vagina. It can become a serious problem if it
is left untreated. People with AIDS can also develop thrush deeper
within their bodies, in their windpipe, esophagus (throat) or lungs.
People who develop thrush as an early symptom of HIV should talk
to their doctor about starting medication to prevent PCP (an AIDS-related
pneumonia), even if they have over 200 T-cells.
What are the signs and symptoms of thrush?
In the mouth, thrush looks like creamy white patches or small red
spots on the tongue, roof of the mouth (also called the hard palate),
gums or throat. Crusting on the corners of the mouth is also a symptom
of thrush. Thrush can make it difficult or painful to swallow and
can cause chest pain. It can cause nausea and make your food taste
different.
Your doctor can usually tell if you have oral thrush by checking
your mouth and throat. X-rays or visual examination of your esophagus
and stomach with a special instrument called an endoscope may also
be necessary for more serious cases.
Thrush in the vagina is also called a "yeast infection." The signs
of a yeast infection include a thick, cottage-cheese-like vaginal
discharge, itching and burning. The vaginal lips (called the labia)
may also be red, tender and swollen. Many women get yeast infections,
but women with HIV often get yeast infections that keep coming back.
(See the Fact Sheet on vaginal
thrush.)
Can thrush be treated?
Yes. For thrush in the mouth or throat, your doctor will probably
give you a liquid medication or a tablet that dissolves in your
mouth. For thrush in the vagina, your doctor will probably give
you a cream or an insert (suppository) that goes inside the vagina.
This is called local treatment. If local treatment doesn't work
or if the infection is severe, then your doctor might decide to
give you pills that treat your whole body. This is called systemic
treatment. Most thrush infections go away with proper treatment.
How can thrush be prevented?
The same medicines used to treat thrush are often used to prevent
thrush before it appears. However, excessive use of these drugs
can cause the yeast to become resistant to treatment. These drugs
can also lead to side effects, like skin rashes or upset stomach.
Some drugs used for HIV-related problems, such as prednisone (a
steroid) and certain antibiotics can lead to thrush. You should
talk to your doctor about whether taking medicine to prevent thrush
is right for you.
Also, some changes in diet may help you prevent or reduce thrush.
It might help to cut down on dairy products and foods made with
sugar or yeast. Some people have found that eating large amounts
of garlic or taking garlic pills helps. Taking acidophilus pills
or powder may help. Eating yogurt that contains live acidophilus
culture (or applying yogurt directly to the vagina) may help to
prevent vaginal thrush.
Ask your doctor about the following medicines for treating and
preventing thrush:
Localized Treatments:
• clotrimazole (Lotrimin and Mycelex vaginal inserts; Mycelex
oral lozenges). Lozenges are medicated tablets that dissolve slowly
on your tongue
• nystatin (oral lozenges; swish and swallow liquid)
• amphotericin B (Fungizone swish and swallow liquid)
• miconazole (Monistat vaginal inserts)
• terconazole (Terazol vaginal cream and inserts)
• butoconazole (Femstat vaginal cream)
Systemic treatments for thrush that recurs frequently or spreads
further into the body:
• ketoconazole (Nizoral pills)
• itraconazole (Sporanox)
• fluconazole (Diflucan pills)
For life-threatening or drug-resistant thrush infections:
• amphotericin B (Fungizone intravenous; Abelcet injection)
• amphotericin B - liposomal formations (AmBisome, ABLC, Amphocil)
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