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Thrush is a common minor ailment, which often only affects women of childbearing age and it is mainly caused by a yeast-like organism known as Candida albicans. Thrush in women is referred to as “vaginal thrush”.

Candida albicans, lives naturally inside a woman’s vagina, or the mouth and intestines of any healthy adult. This common organism does not normally cause any problems although under certain circumstances changes in the pH of the vagina may disturb the balance between this and other organisms which will allow the candida to spread. This is when it starts to cause problems that can create several unpleasant symptoms.

The hormone, oestrogen, released in a woman’s body also creates a favourable environment for the growth of candida albicans.

Most women produce some vaginal discharge throughout their menstrual cycle. This is absolutely normal and it is usually a clear, watery mucus, which becomes thicker and whiter in the two weeks before the period begins.

It is estimated that at least 80% of women will suffer from vaginal thrush at some point in their lives.

The main symptoms of vaginal thrush are as follow:

- Redness and/or swelling of the vagina or vulva.

- Soreness in and around the vaginal area, since the tissues in that area become inflamed. Rubbing of the area will make the symptom worse.

- Itching inside and outside the vagina (this may feel worse at night, also scratching will worsen the symptoms).

- The production of a thick, white non-smelly vaginal discharge, sometimes also referred to as looking like a “cottage cheese”.

There is also another symptom that sometimes is experienced when suffering from vaginal thrush like a burning or stinging sensation when passing waters, due to the urine coming into contact with the inflamed tissues.

This can be misinterpreted with symptoms of cystitis. When suffering from vaginal thrush the area around the vagina can get very irritated or sore, causing the urine to provoke a burning feeling which in return may make you want to pass urine less often due to the pain it causes. When this symptom is present in cystitis, a woman will want to urinate more often.

There are other symptoms that have been reported by sufferers of vaginal thrush that should be brought to the attention of a healthcare professional or doctor.
These are as follow:

- Any pain or bleeding experience during sexual intercourse (this could be due to the friction caused on the inflamed tissues). - Bleeding in between menstrual periods or periods that become heavier than usual.

- Also vaginal thrush does not cause visible sores or ulcers around the vagina or unusual bleeding, and if these symptoms are present it could indicate the presence of a different type of infection and the sufferer should seek medical attention immediately.

- If pain is being experience in the lower abdomen.

- Any woman who is suffering from thrush for the very first time or who is having repeated attacks (more that two attacks in six months), should have the condition properly diagnosed by her doctor before using any treatments.

- Raised temperature, which can indicate a serious bacterial infection (toxic shock syndrome).

- If the vaginal discharge is yellow or green in colour or bloodstained and has a strong smell.

Men, pregnant women or people who have tried treatments without any satisfaction should always be referred for medical advise.

The types of treatments for this kind of infection are anti-fungals since this type of yeast is very similar to fungi.

Effective anti-fungal treatments known to be sold over the counter (OTC) are clotrimazole, econazole and miconazole, which are found in external/internal creams or internal pessarie forms.

There are pessaries (containing 500mg of clotrimazole) or internal creams (containing 10% w/w clotrimazole) and these should be used at night before going to bed.

External creams (containing 2% w/w clotrimazole) should be applied to the genitals at least twice a day for around three days to ensure success of the treatment.

Fluconazole is another popular one taken by mouth rather than applied topically. It is a single dose tablet containing 150 mg of the drug, and is also considered more convenient and less invasive; it can relive the symptoms within 24 hours.

Unfortunately it can cause unwanted side-effects such us nausea, abdominal pain, flatulence, headache and diarrhoea.

Fluconazole should not be used during pregnancy and even though it is licence to treat male thrush as well as female, it is recommended to seek advise from a professional healthcare advisor before its use in men.

The aim of the treatment is to temporarily kill the candida in the vagina or to reduce its levels (and we use the term temporarily only because since candida grows naturally inside the body, it is impossible to permanently eradicate it, which is why thrush can re-occur).

Warning: Pessaries or creams may damage latex condoms and diaphragms so the effectiveness of the contraception used may be reduced.

Anti-fungal treatments should not be sold to anybody under 16 or who are over the age of 60 since vaginal thrush is rare among people of these ages and will require further investigation by their doctors.

Causes of vaginal thrush infections:

- Poor general health which causes a lower immune system which leads to less than normal natural defences against infections.

- Sexual intercourse, since it can cause damage to the vaginal tissues through lack of lubrication and in return allow candida to grow.

Vaginal thrush is not classified as a sexual transmitted infection even though it can be triggered by sexual intercourse as it can be passed on from one partner to the other if one of either partners suffers from the infection (it can happen without being sexually active). For the most part, men do not show any signs of having thrush but if their partner suffers from it, they will need to be treated as well to prevent re-infecting their partners again.

- Certain medicines such as antibiotic treatments will kill the good bacteria that keeps the body balanced and therefore increase the candida within the body causing infections.

Medicines such as antibiotics are well known for causing vaginal thrush since they change the body’s normal bacteria levels. They kill the good bacteria in the body that keeps Candida from spreading as well as the bacteria that the antibiotic was given for.

- Pregnancy or contraceptives alter the balance of hormones in the body, which can lead to candidal growth. Any changes of hormones in the body can also cause the levels of Candida yeast to increase, so pregnant women or those on the contraception pill or other hormone treatments are likely to develop episodes of vaginal thrush.

- Diabetes and other diseases can cause the levels of sugar in the urine to rise and therefore allow candida levels to increase. - Irritants such as bubble baths or condoms irritate and damage the tissues in the vagina, allowing candida to grow.

- Tight or synthetic clothing must be avoided since candida thrives in warm, moist conditions just like any other fungal infections and these materials help create that perfect environment.

Candida albicans can sometimes affect babies or young children who will suffer from the infection in their mouths, this is known as oral thrush. Also some types of nappy rush can be due to this particular yeast-like organism.

There are different ways to help prevent thrush from developing, these are as follow:

- Always wipe from front to back after using the toilet, to avoid spreading candida from the anus to the vagina.

- Wash the genital area every day with a perfume-free and fragrance-free product, do not use soaps. There are special feminine washes available to buy over the counter.

- Avoid antiseptics, vaginal talcs and perfumed deodorant sprays. - Do not wear tight fitting pants or synthetic underwear.

- Women who suffer from thrush regularly should increase the in-take of “friendly bacteria” in their diets and should try eating live (bio-active) natural yoghurts to increase the number of lactobacilli in the gut.

- Hosiery is also now available with briefs treated with an anti-microbial protection which helps in the prevention and management of thrush.

Treatments for male partners of women with vaginal thrush:

Most men suffer from thrush without realising it since they do not experience any of the symptoms the way women would. Thrush in men is known as “penile thrush“. Men are normally advise to use anti-fungal creams on their penis two or three times a day to avoid re-infecting their partners if they have had any episodes of vaginal thrush that had to be treated.

Treatment is recommended to be used at the same time as their partners.

If any man presents himself with any symptoms such as discharge from their penis or visible sores on it, they should seek medical advise as soon as possible since these could be signs of something completely different and far more serious.

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