Thrush

=Thrush=

What it is
Vaginal thrush is a common infection caused by an overgrowth of yeasts in the vagina. About 75 per cent of women will have thrush in their lifetime. The most common yeast involved is called //Candida albicans.// This yeast often lives in small numbers in areas of the body like the bowel, mouth and vagina. It generally causes no problems.

Thrush develops when the numbers of yeast grow excessively. This can occur in other parts of the body, such as the mouth. Thrush is also known as candidiasis.

- Antibiotic use - Oral contraceptive use - Diabetes - Pregnancy - General illness and immune system disorders.
 * Causes:**

- People with an impaired immune system, such as those with AIDS. - People with diabetes. - Pregnant women. - Those on certain medications (e.g. antibiotics, oral contraceptives or corticosteroids). - People who have leukaemia or are receiving cancer treatments and who would have a low white blood cell count.
 * High risk:**

Symptoms
//Approximately 10-20% of women with thrush are asymptomatic. Symptoms are often worse in the week before menstruation.// - Vaginal discomfort – itching or burning - A thick white discharge with a ‘cottage cheese’ appearance - Redness or swelling of the vagina or vulva - Stinging or burning while urinating and during sex.

- under 16 or over 60 years of age - they are pregnant - in pain or have a fever - vaginal discharge has an unpleasant odour or is yellowish or greenish
 * Refer if:**
 * -** experiencing the first episode of vaginal candidiasis

How to Treat
//Women who suspect they may have a vaginal infection should visit their doctor to ensure their symptoms are due to thrush and not another vaginal infection or condition (bacterial vaginosis, dermatitis//)

//Vaginal cream//, insert 1 applicatorful into the vagina daily at bedtime until contents of the tube are used (10% single dose; 2% 3 doses; 1% 6 doses). //Pessary//, insert 1 pessary into the vagina daily at bedtime until contents of pack used (500 mg single dose; 100 mg 6 doses). //Information on how to insert a pessary can be found [|here]//
 * Clotrimazole**

//Treatment//, 150 mg single dose. //Prophylaxis//, initially 2–3 doses of 150 mg given 3 days apart, then 100–150 mg once a week for up to 6 months in severe recurrent cases.
 * Fluconazole** //once topical therapy has failed//

If the patient is on Warfarin, do not use miconazole, clotrimazol, econazole or fluconazole as warfarin's anticoagulant effect may be increased. Use Nystatin instead.

- Single dose preparations can assist compliance - Fluconazole is more expensive and is not recommended for pregnant women. - Fluconazole should be reserved for severe cases, as indiscriminate use can lead to fluconazole resistance. It also exhibits a greater side-effect profile and interacts with other medicines. - If a cream is used, it may be applied internally as well as externally to the affected areas. - Those who are pregnant should be cautious when using an applicator. Prefer to administer vaginal thrush medications using a clean finger - Ensure to complete the course of the treatment, even during menstruation and if symptoms resolve

Other advice
- Thrush is not a sexually transmissible infection (STI), but male partners can sometimes get redness and irritation after sex. - The treatment for thrush can weaken condoms so apply the treatments after you have had sex if you are using condoms.

- Avoid wearing tight fitting clothing like jeans and pantyhose and underwear made from synthetic fibres. This creates a moist, warm environment which encourages the growth of Candida. - Remove wet or damp bathing suits immediately after swimming. - Avoid douching, perfumed soaps, bubble baths and bath salts, perfumed toilet paper and panty liners. - Change underwear daily. - Wash underwear in hot water (to destroy fungi) and double rinse (to remove any irritating detergent). - If prescribed antibiotics for a health complaint, ask the doctor about also taking anti-fungal preparations in combination as a preventative measure. - Perfumed sprays or other 'feminine hygiene' products (such as douches) on the genital area can also irritate the skin and keep the thrush going. - After going to the toilet, wipe from front to back using a clean piece of toilet paper each time
 * Prevention:**

Consuming yoghurt or other products containing the ‘good’ bacteria, lactobacilli, or using plain yoghurt in the vagina appear to be of little benefit in treating or preventing thrush.

Additional Resources
[|Better Health Channel - Thrush] [|Women's Health - Thrush and Other Vaginal Infections] [|myDr.com.au - Thrush: What is it?] [|Parenting and Child Health - Thrush] [|mypharmacy.co.uk]: contains diagrams on how to insert a pessary [|Treatment for thrush?]