Thrush, also called yeast infection or candidiasis, is an overgrowth of yeast that leads to a range of unpleasant symptoms, such as itching and soreness around the woman’s body, particularly the vagina. Most women will have thrush at least once during their lives, and many will have more than one episode. But for some women, thrush keeps coming back. Recurrent thrush can affect a woman’s sex life and self-image, and may be a sign of a more serious health problem. Even if you only have thrush once, it can be extremely uncomfortable. Also, if you don’t know what’s happening or why, the condition can be very stressful. This online leaflet explains what thrush is, what causes it, how to treat it and what you can do to help prevent it in the future.
Thrush is caused by yeast, already present in the body, that grows out of control. This yeast is almost always Candida albicans, but another, more resistant yeast, Candida glabrata, can also lead to thrush. Many women, (as well as men and children) carry yeast in and on their bodies without any problems. Yeast usually lives in the intestines, vagina, mouth and skin, where ‘friendly’ bacteria help keep yeast levels low. When this balance is disrupted, however, and the yeast is allowed to grow unchecked, it causes havoc in the body. The vagina is one of the areas most likely to be affected by thrush. Although the vagina is generally too acidic for yeast to grow out of control, it’s sensitive to small changes and can easily become an ideal environment for yeast to flourish. Too much yeast irritates the vaginal tissues and this leads to the typical symptoms of thrush.
Basic Treatments for Thrush
Treatments can be bought over the counter at a chemist, but they may be cheaper (or free) if you get them by prescription. Thrush is caused by a fungus (candida), and is therefore treated with antifungal drugs. Treatments are available as pessaries to be inserted into the vagina, creams to be put on the vulva and/or into the vagina or capsules to be swallowed.
- Antimycotics: In clinical settings, candidiasis is commonly treated with antimycotics—the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole and topical ketoconazole. For example, a one-time dose of fluconazole (as Diflucan 150-mg tablet taken orally) has been reported as being 90% effective in treating a vaginal yeast infection. This dose is only effective for vaginal yeast infections, so other types of yeast infections may require different treatments.In severe infections (generally in hospitalized patients), amphotericin B, caspofungin, or voriconazole may be used. Local treatment may include vaginal suppositories or medicated douches. Gentian violet can be used for breastfeeding thrush, but pediatrician William Sears recommends using it sparingly, since in large quantities it can cause mouth and throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals.
- Home Remedies versus Medical Attention: While home remedies may offer relief in minor cases of infection, seeking medical attention may be necessary, especially if the extent of the infection cannot be judged accurately by the patient. For instance, oral thrush is visible only at the upper digestive tract, but it may be that the lower digestive tract is likewise colonized by Candida species.Treating candidiasis solely with medication may not give desired results, and other underlying causes require consideration. For example, oral candidiasis can also be the sign of a more serious condition, such as HIV infection or other immunodeficiency diseases.
- Beware of Medication Resistance: It is possible for Candida Albicans to develop a resistance to the drugs used to treat it, as seen from research done involving fluconazole, one of the drugs that is used to treat Candidiasis. In this case, the recurring infection would have to use a different prescription, and it is possible that resistance is slowly built to many of the available medications used to treat the yeast infection.
- Diaper Hygiene and Sugar Diet: Baby girls with diaper rash should have their diaper areas kept clean, dry, and exposed to air as much as possible. Sugars assist the overgrowth of yeast, possibly explaining the increased prevalence of yeast infections in patients with diabetes mellitus, as noted above. As many Candida reside in the digestive tract, dietary changes may be effective for preventing or during a Candida infection. Due to its requirement for readily fermentable carbon sources, such as mono or dimeric sugars (e.g., sucrose, glucose, lactose) and starch, avoiding foods that contain these nutrients in high abundance may help to prevent excessive Candida growth.
- Pessaries and Creams: Pessaries and creams work directly at the site of infection—in the vagina and on the outer lips of the vagina. Pessaries are bullet-shaped tablets that can be either hard or waxy. They need to be pushed high into your vagina with your finger or an applicator. There are two types of creams used to treat thrush: vaginal and vulval.Vaginal creams work internally and, like pessaries, are inserted into the vagina using an applicator. Vulval creams are usually used with an internal treatment to help soothe and treat itching outside the vagina. Pessaries and creams can be messy—they melt and leak out into your pants—so it’s best to insert them at night just before you go to bed. You may also want to use a pantyliner, as some treatments are colored and can stain.The length of treatment varies with different brands of pessaries and creams. It may last one day, three days, six days or 14 days. You don’t need to stop treatment if you get your period. In fact, it’s important to complete the full course of treatment, even if your symptoms seem to have cleared.
The active ingredient in pessaries and creams may be clotrimazole, econazole, fenticonazole, miconazole or nystatin. Nystatin is a little bit different than the other drugs. It’s a more general antifungal that works against a range of fungi and yeast. It can take longer and may be less effective at curing thrush than the other antifungal preparations.
Warning: If you have a peanut allergy, avoid vaginal creams that contain arachis oil. Betadine pessaries used to treat recurrent thrush are iodine-based and may cause irritation. To reduce irritation, moisten the pessary with water before inserting it. Pessaries and creams containing miconazole may cause bleeding and bruising if taken at the same time as warfarin—a prescription blood thinning drug.
- Oral Medication: When thrush keeps coming back, it may be a signal that yeast has taken over another part of the body, such as the intestines. If this is the case, vaginal pessaries and creams will not be able to treat the whole problem. Oral tablets or capsules fight yeast throughout the body and therefore are often prescribed for women who have recurrent thrush.Capsules are available either as a single dose (fluconazole) or as two capsules to be taken in the same day (itraconazole). Many women prefer pills to creams or pessaries, but they are more likely to cause side effects and should not be used if you’re pregnant, breastfeeding or taking certain medication.Warning: If you’re pregnant or breastfeeding, you should not use oral treatments for thrush. Some pessaries and creams may be safe to use, or you may want to consider alternative treatments. It’s always a good idea to check with your doctor or midwife before using any treatment while you’re pregnant.
Also, oral medication for thrush may cause nausea, diarrhea, abdominal pain, dizziness or skin rash. It may also cause more serious problems if you are using it at the same time as other drugs such as loratadine (an antihistamine used in some allergy medication). If you’re taking medication for another condition, check with the pharmacist or your doctor before taking antifungal tablets.
Alternative Treatments for Thrush
There is also a range of alternative or complementary treatments for thrush. Not all of these treatments are supported by research, but many women find them useful. Complementary treatments tend to be most effective when used as soon as you begin to notice the symptoms of thrush.
- Calendula: A byproduct of marigold flowers, calendula is both antifungal and soothing. Calendula pessaries for thrush are available at some health food stores. Calendula cream or gel may be helpful if applied directly on the irritated area outside of your vagina. Do not put a cream or gel into your vagina unless it says on the package that it is safe to use internally.
- Garlic: Garlic has strong antibacterial and antifungal properties, and may help stop thrush in some women. Peel a clove of garlic (be careful not to nick it), wrap it in muslin to make sure you can remove it and insert it into your vagina. Leave the garlic in overnight. Be prepared to smell quite strongly of garlic while you’re using this treatment.
- Tea Tree Oil: Some women find tea tree oil helpful in stopping thrush. Its effectiveness in fighting candida albicans is also supported by scientific studies. To use tea tree oil for thrush, put tea tree oil on the tip of a tampon and insert it into your vagina, then put tea tree on a pantyliner or towel or dampen cotton wool with tea tree (mixed with water) and gently wipe around the vaginal area
It’s important to consider that Candida species are frequently part of the human body’s normal oral and intestinal flora. Treatment with antibiotics can lead to eliminating the yeast’s natural competitors for resources, and increase the severity of the condition. As such, approach this condition with caution; too much of a certain treatment can open the way for even more maladies and diseases.
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