| Vaginal Thrush
What is vaginal thrush?
Vaginal thrush is a vaginal infection caused by a fungus or yeast.
It is also called vaginal candidiasis, monilia, or a "yeast"
infection. It is caused by the same kinds of yeast that cause thrush
in the mouth (oral thrush) or the food pipe (esophageal candidiasis).
Yeast can also grow in the blood and cause a very serious infection.
Yeast grows in the vagina without causing infection. A vaginal
yeast infection occurs when the yeast overgrows, causing symptoms.
This happens when the normal health of the vagina is disrupted.
Almost all women get vaginal yeast infections from time to time.
For example, taking antibiotics for a bacterial infection often
will lead to an overgrowth of yeast in the vagina. However, when
a woman gets yeast infections "all the time" or can't
get rid of the infection despite proper treatment, it is often due
to a chronic illness. Diabetes is an illness that often leads to
chronic vaginal yeast infections. HIV infection is another.
What are the signs and symptoms of vaginal thrush?
Vaginal thrush commonly causes a thick, white, curd-like ("cottage
cheese") discharge. It may either have no odor, or there may
be a bad odor, especially during menstruation. It can cause a lot
of itching and irritation both inside and outside of the vagina.
The vulva (vaginal lips) may look very red and inflamed, and may
burn, sting, or itch. This irritated and inflamed tissue is fragile.
Scratching or sexual activity may cause small cuts. In very severe
cases, ulcers may form, and other bacterial infections may occur
in the damaged tissues.
How is vaginal thrush diagnosed?
Many women can tell that they have a yeast infection by its symptoms.
However, a correct diagnosis is essential. If you have any of the
symptoms and are not sure what infection you have go to your doctor!
The vaginal infection you have may be caused by other types of germs.
Two common causes are trichomonas and bacterial vaginosis. You will
need to have a pelvic exam so the discharge can be examined under
a microscope. In some cases, a culture may be taken and sent to
the laboratory for diagnosis. Some doctors will give you medicine
for a yeast infection without examining you, but this practice can
lead to misdiagnosis and worsening symptoms.
How is vaginal thrush treated?
The standard treatment for vaginal yeast is to place an antifungal
medicine inside the vagina in the form of a cream or suppository.
Treatments are usually used for a few days. However, if you have
HIV infection, you may need to use the medicine for a longer time
to keep the infection from returning.
The following are common antifungal medications. Most of these
work equally well. If one medication doesn't work, another one should
be tried. Some formulations of these medications may be purchased
at any drugstore without a prescription.
- butoconazole (Femstat)
- clotrimazole (Mycelex or Gynelotrimin)
- miconazole (Monistat)
- nystatin (Mycostatin)
- terconazole (Terazole)
- tioconazole
Creams and suppositories are safe to use, even if the infections
frequently return. However, some infections simply won't respond
very well or at all to these treatments. These yeast infections
will usually respond better to oral antifungal medications such
as ketoconazole (Nizoral), or fluconazole (Diflucan). Again, a single
dose treatment is not recommended.
There are also home remedies for yeast infections (boric acid,
garlic, or betadine) that may work well for some women if used correctly.
Can vaginal thrush be prevented?
Primary prevention of vaginal yeast is not possible or wanted because
normal amounts of yeast are needed for good health. Some women find
that it helps to prevent recurrences of yeast overgrowth if they
limit the amount of sweets and sugar in their diet. It also helps
not to douche and to wear cotton panties and skirts or loose-fitting
pants to allow the vaginal area to "breathe."
If infections keep coming back, you may need another pelvic exam
to confirm the diagnosis. You can use the cream or suppository treatment
on a schedule that keeps the symptoms under control. This might
be once a week, three times a week, after sexual activity, or whatever
schedule works.
If recurrences become bothersome it may be useful to take stronger
medication using antifungal pills ketoconazole (Nizoral) or fluconazole
(Diflucan). These medications will usually hold down vaginal and
oral thrush if used. However, over time, the fungus may become used
to these medications and the medicines may not work as well.
Ketoconazole (Nizoral) or fluconazole (Diflucan) can cause side
effects (rash, nausea or abdominal cramps) and can interfere with
the action of other medications. They also require monitoring for
liver and kidney problems. On the other hand, for many women who
have suffered with constant vaginal thrush, weekly oral medication
provides great benefit. Talk with your doctor about whether taking
medicine to prevent chronic vaginal yeast infections is right for
you.
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