What Is Yeast Infection Or Candidiasis? What Is Vaginal Thrush?

Vaginal thrush (thrush) is a yeast infection caused by a type of fungus of the candida species, usually Candida albicans. It can affect all women, but is more common among women who are pregnant, those who have weakened immune systems, and women aged 30 to 50. Thrush is generally recurring - it comes back. The fungus, candida albicans, exists naturally in the vagina. As long as it does not multiply too much a woman will not notice it is there. However, if can sometimes multiply to such an extent that it causes swelling of the vagina and vulva.

The vulva refers to the external genital organs of the female. In laypeople's speech the vagina is used to refer to female genitals in general. However, strictly speaking, the vagina refers to the internal structure, while the vulva refers to the whole exterior. In this article, the two terms are used with their proper meanings.

Candidal balanitis (inflammation of the head of the penis) can develop in the male partners of women with thrush; however, it is very rare. Male genital yeast infection is much less common than female genital yeast infection.

Thrush is not considered to be a sexually transmitted infection.

What are the symptoms of vaginal thrush?

• Itching of the vulva
• Soreness and irritation in the vulva
• Vaginal discharge
• Superficial dyspareunia (pain, discomfort during sexual intercourse)
• Dysuria (discomfort, pain during urination)

Women can also experience inflammation of the vagina/vulva (vulvovaginal inflammation). The signs of vulvovaginal inflammation are:

• The vagina and/or vulva become red (erythema)
• The skin of the vagina cracks
• Swelling (if the swelling becomes severe there can be inflammation)
• Sores in the surrounding area (rare)

If a woman has sores in the surrounding areas, this could also be an indication of other fungi, or herpes simplex.

A vaginal discharge is also common. The discharge might be watery, white, or with pus (purulent).

What are the causes of thrush? Who is more susceptible to thrush?

In most cases, thrush is caused by the Candida albicans fungus. This fungus is generally present in the mouth and vagina.

• Pregnancy - changes in a pregnant woman's hormone levels may make her more susceptible to develop thrush.


• Diabetes - if a woman's diabetes is poorly controlled, she is at a significantly higher risk of developing thrush.


• Antibiotics - when women take antibiotics their chances of developing thrush increase substantially. According to the NHS (National Health Services, UK), approximately 30% of women who take systemic or intravaginal antibiotics develop thrush.


• Weakened immune system - women with a weakened immune system, such as with HIV/AIDS, recipients of chemotherapy, and lupus are more likely to develop thrush, compared to other women.


• Contraceptives - some studies indicate that oral contraceptives raise the risk of thrush. However, other studies indicate there is no increased risk.


• Oral sex - women who have oral sex are at greater risk of developing thrush (the woman being the recipient of oral sex).

There is evidence that tight fitting clothing may raise the risk of developing thrush. However, this is not the case with sanitary towels.

Diagnosis of thrush

A doctor will diagnose thrush by checking for the signs and symptoms. However, if the thrush is recurring, even after treatment, it is advisable to have a vaginal secretion test to make sure it really is a fungus causing the problem, and not another condition, such as bacterial vaginosis, or trichomoniasis.

What is the treatment for thrush?

A 1 to 3 day course of antifungal medicine will usually be enough to clear up the infection. If the symptoms are severe the treatment will last longer.

Medications can be taken orally (by mouth) or intravaginally. Medications administered intravaginally for thrush are called intravaginal pessaries.

Oral medications can have some side-effects, including nausea, upset stomach, constipation, diarrhea, vomiting, and/or bloating.

Intravaginal pessaries include clotrimazole, econazole, or miconazole. They are much less likely to cause side effects, however, they can be awkward to use and cause mild irritation when inserted. Some women say they cause stinging initially. They can also damage latex condoms and diaphragms (types of contraceptives).

If the patient is aged 12-16 she is generally given an oral antifungal, such as fluconazole, or itraconazole.

If a woman has sores in her vulva there are topical creams that can be applied, such as clotrimazole or econazole.

If the thrush does not clear up after treatment the patient should tell her doctor.

Pregnant and breastfeeding women must take intravaginal pessaries and not oral antifungal medications, as they can be passed on to the baby. Examples of intravaginal pessaries prescribed for pregnant and breastfeeding mothers are clotrimazole, econazole, or miconazole. A full course usually lasts for seven days or more.

Pregnant women must be careful when inserting a pessary with an applicator, as this may injure the cervix. In most cases, application by hand is recommended.

Some medications are available without the need for a doctor's prescription. Flucanozole is an OTC (over-the-counter) medication in most countries, and is available usually as a single dose tablet.

Women who have developed thrush for the first time are advised to see their doctors, rather than going to the pharmacy to self-treat. It is important that thrush is diagnosed initially. Also, over-the-counter medications should not be used long-term without checking with a doctor first - this would be discussed during a woman's initial doctor's visit and/or subsequent ones.

Things you can do to ease the symptoms of thrush:

• Avoid using perfumed soaps, vaginal deodorants, shower gels, or douches to wash your vaginal area. Use just water.
• Avoid using latex condoms.
• Avoid using spermicidal creams.
• Avoid using lubricants.
• Avoid wearing synthetic clothes, and tight-fitting clothes. Cotton underwear is best.

The following women should go back to see their doctor if symptoms return:

• Pregnant women.


• Those with lower abdominal pain (stomach pain) .


• Women whose symptoms have changed.


• Women who have not seen a doctor for over a year and have had two recurrences in a 12-month period.


• A woman who has had an STI (sexually transmitted disease) previously (or her partner) .


• A woman whose antifungal medications were ineffective.


• A woman who has had a bad reaction to antifungal medication.

Maintenance therapy for thrush

Maintenance therapy is a term used for managing recurring thrush. Studies indicate that oral fluconazole, taken weekly is effective in preventing recurrence. Other studies have also found that oral itraconzole, or intravaginal clotrimazole, taken monthly, are also effective.