What is Vaginal Thrush?

Vaginal thrush, also known as a vaginal yeast infection or candidal vulvovaginitis, is a common fungal infection in biological women. Up to 75% of women will experience at least one episode of vaginal thrush in their lifetime [1]. This condition is caused by the increased growth of yeast in the vagina called Candida Albicans. Whilst uncomfortable, they can be treated effectively by consulting a GP.

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Vaginal Thrush Symptoms

Below are symptoms [2] that are associated in those with vaginal thrush [2]. If you experience any signs of thrush, seek medical care as soon as possible.

• Vaginal itching
• Dysuria or vaginal burning and tingling
• Swollen vulva or vagina
• Dyspareunia or genital pain during sex
• Presence of a white and sticky discharge from the vagina
• A vaginal rash over the skin

What Causes Thrush?

Fungal infections cause vaginal thrush which arise from the growth of the Candida yeast family, most commonly Candida Albicans (in 90% of cases) [2]. The Candida species usually lives in the human gut for most people but can spread to other body parts. Inflammatory changes in the vagina are caused by the spread of Candida into the outer lining. Over time, persisting inflammation in the genitals lead to symptoms, such as discharge and itching.

This overgrowth and imbalance of Candida can be caused by [3]:

• Taking antibiotics
• During pregnancy
• Hormonal changes
• During periods
• Other conditions (e.g. diabetes, pancreatitis, etc.)
• Eating a high-sugar diet
• A weakened immune system (e.g. HIV, chemotherapy, etc.)
• Anxiety and stress
• Smoking

Is Thrush Contagious?

Thrush usually occurs due to environmental changes inside the genitals and/or vagina [4]. However, it’s still contagious and sufferers can pass on yeast infections to sexual partners, particularly if they have a weakened immune system, diabetes and/or uncircumcised. 15% of men who have sex with women with yeast infections can develop an itchy rash on their penis [4]. Female partners may also be at risk after intercourse.

Can you have sex with thrush?

You can still have sex with thrush, but a condom or thrush creams are advised to protect passing it on. Although not considered a sexually transmitted infection (STI), it can still irritate your partner even with protection (e.g. condoms, dams, etc.). Additionally, having sex during infection can aggravate symptoms and prolong recovery [5].

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Tests and Diagnosis

Self-diagnosis of vaginal thrush is not advised, as symptoms can overlap with other conditions. Additionally, improper care and self-treatment can be harmful. If you experience any of the symptoms or suspect thrush, you should consult a GP. They will be able to perform comprehensive medication questioning, a physical examination of your genitals and/or a swab to confirm a diagnosis.

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Vaginal Thrush Treatments

Treatments can be provided by a GP to ease symptoms and speed up recovery. Examples include:

Topical Anti-Fungal Therapies

First-line treatment of vaginal thrush includes anti-fungal therapies in the form of vaginal thrush creams and pessaries. Pessaries are dissolving tablets that can be inserted into the vagina through a device called an applicator. These treatments help resolve symptoms by eliminating the yeast infection found in the vagina. Your GP may recommend one large dose or several smaller doses. However, you may want to re-consider sexual activity as these creams and pessaries can damage contraceptives (i.e. condoms, dams, etc.) [6].

Oral Medications

Anti-fungal medications, such as itraconazole and fluconazole in the form of oral tablets, can also be prescribed as treatment [6]. Although more convenient, they are more expensive than topical treatments. Additionally, oral medications are not recommended for women that are pregnant or breastfeeding [6]. Anti-yeast creams can also be used in combination with these vaginal thrush medications.

Self-Care

Self-care treatments at home can also help relieve symptoms. Examples include [6]:

• Using non-soap substitutes to clean your vagina.
• Avoid applying perfumed products around your vagina.
• Wiping from front to back after finishing on the toilet to avoid Candida spreading from the anus.
• Applying emollient around the vagina to protect the surrounding skin.
• Wearing loose-fitting and natural underwear/clothing. Avoid tight-fitting and synthetic materials.

Recovery

Depending on the severity of the condition, treatment may or may not be required. While mild conditions can resolve as quickly as 3 days, moderate to severe episodes can take anywhere between 1-3 weeks [7]][9].

How to prevent thrush?

Prevention is better than cure. Vaginal thrush is no exception. Incorporating elements of the self-care treatment section during your daily routine can help prevent thrush. Other strategies to help prevent thrush include [8]:

• Changing underwear daily
• Avoid wearing wet undergarments for long periods, such as bathers and swimsuits
• Keeping your blood sugars under control
• Avoid exposing the vagina to overly moist environments, such as bubble baths and douches.

Complications

If left untreated, symptoms of vaginal thrush can worsen. Persistent thrush can also lead to additional side effects, such as fatigue, stomach problems and oral thrush [9]. Typically, those with other conditions (e.g. diabetes, pancreatic cancer, etc.) or immunocompromised are likely to suffer from these additional complications. These individuals may need a longer duration of treatment.

Recurring thrush

Around 5% of premenopausal women will experience recurrent vaginal thrush [1]. These individuals will have multiple episodes within 12 months. A range of factors can contribute to recurrent thrush, including infections caused by certain strains of Candida, the microbiota of the vagina, genetics, the body’s hormone profile, diet, sexual behaviours and choice of clothing [1][10]. Recurring thrush can be more challenging to manage, so consulting a GP is essential for receiving the appropriate treatment.

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References

1. Sheary, B., & Dayan, L. (2005). Recurrent vulvovaginal candidiasis. Australian family physician, 34(3).
2. Jeanmonod, R., & Jeanmonod, D. (2020). Vaginal candidiasis. In StatPearls [Internet]. StatPearls Publishing.
3. https://www.healthdirect.gov.au/what-causes-vaginal-thrush
4. https://www.womenshealth.gov/a-z-topics/vaginal-yeast-infections
5. https://www.healthline.com/health/can-you-have-sex-with-a-yeast-infection#transmission
6. https://patient.info/sexual-health/vaginal-discharge-female-discharge/vaginal-thrush-yeast-infection#nav-6
7. https://www.healthline.com/health/womens-health/how-long-does-yeast-infection-last#_noHeaderPrefixedContent
8. https://www.healthdirect.gov.au/vaginal-thrush-prevention
9. https://www.healthline.com/health/untreated-yeast-infection#duration
10. Rosati, D., Bruno, M., Jaeger, M., Ten Oever, J., & Netea, M. G. (2020). Recurrent vulvovaginal candidiasis: an immunological perspective. Microorganisms, 8(2), 144.