What few women want to talk about

Don't feel too optimistic if you have been lucky enough in the past to escape this yeast infection. According to Dr. Patricia Okeyo, a specialist obstetrician gynaecologist practicing at Netcare Rosebank Hospital, most women will experience thrush at least once in their lives.

Thrush is a treatable infection and with a few easy steps you can even try to escape being infected altogether. “But first you need to understand what it is and what exactly causes it,” Dr. Okeyo says.

A yeast named Candida, a species of fungus, is the culprit. Although it is kind of a disgusting thought, there is usually a small amount of this fungus that naturally lives on your skin, mouth, intestines and around the vaginal area. “But your immune system and the harmless bacteria that also normally live in these areas, usually stop Candida from thriving,” Dr. Okeyo explains. However, whenever this natural balance is disrupted and the yeast is allowed to grow unchecked, it manifests as an infection known as thrush.

The infection is most common in the vagina because Candida thrives in warm, moist and airless parts of the body. But there is also a number of factors that can trigger episodes of thrush. “Firstly there is the use of antibiotics,” says Dr. Okeyo. “About 30 percent of women who take a course of systemic or intravaginal antibiotics, will experience an episode of thrush. This happens because the antibiotics also kill the harmless bacteria that usually stop the yeast from growing unchecked. But although using antibiotics increases your risk of getting thrush, the Candida fungus must already be present to develop the condition.”

Secondly, pregnant women are also more likely to get thrush. “Pregnancy can change the levels of female sex hormones, such as estrogen and make you more likely to develop thrush. During pregnancy the Candida fungus is more common and recurrent infection is also more likely.”

The third trigger factor is diabetes that is poorly controlled, and lastly an immunodeficiency. “If your immune system is weakened by a condition such as HIV or AIDS, your risk of developing thrush is increased. As in the case of antibiotics, this is because your immune system, which usually fights off infection, is unable to effectively stop the fungus from spreading.”

There are also a couple of possible risk factors that can lead to thrush, like wearing tight-fitting clothing because it restricts airflow. “And women who have oral sex may be at greater risk of developing thrush, although there is little evidence to support that the condition is spread during sex,” Dr. Okeyo adds.

As mentioned, most women will have thrush at least once during their lives; therefore there is no reason to feel alone or ashamed if you develop this condition. “For some women it is even a recurring problem even though we do not know what makes some women more prone to thrush than others, except the risk factors as mentioned above.”

And don't be afraid that a Candida episode will have a lasting effect on your sexual health. Thrush does not damage the vagina. Even pregnant moms have no reason to worry that it will affect the fetus, as the infection does not spread beyond the vaginal area and will not cause infection in the womb.

But how can you be sure that you have thrush? “If you have a vaginal discharge, which is white and looks like cottage cheese, there is a 50 percent chance that it is thrush. The other symptoms include: vulval itching; vulval soreness and irritation; pain or discomfort during sexual intercourse; and pain or discomfort during urination.”

There is also some precaution you can take to prevent Candida, says Dr. Okeyo. Some women, who have vaginal thrush, use probiotics, such as live yoghurts, to help treat and prevent the condition. “There is no medical evidence that probiotics are effective but, equally, there is no reason to think that they could be unsafe,” she adds. “Your pharmacist will also be able to advise you on over-the-counter medicine, such as creams, that you can get without a prescription.”

However, if you have developed the symptoms of thrush for the first time, you should visit your doctor in order to confirm a diagnosis. “If your symptoms of vaginal thrush are mild and it doesn't make you too uncomfortable, your doctor may recommend a short course of antifungal medicine. Usually this needs to be taken for one to three days. If your symptoms are more severe, you will need to take the treatment for up to seven days. Just ask if there will be any side affects and what you can do to avoid them,” advises Dr. Okeyo.

“Also, over-the-counter treatments should not be used long term without first seeking medical advice. If your symptoms have not improved within seven to 14-days, you should visit your doctor. There are also creams available to treat sore parts of the vulva.”

If your symptoms don't clear up after using treatment, you should always go back to your doctor, especially if it is a recurring problem and you are under 16 or over 60 years of age; you are pregnant; you have abnormal menstrual bleeding, or stomach pain; your symptoms are different from a previous episode of thrush (for example, if the discharge is a different colour, or if you have ulcers, or blisters); you have had two cases of thrush within six months, and you have not consulted a healthcare professional for more than a year; you, or your partner, have previously had a sexually transmitted infection (STI); or you have reacted badly to an antifungal treatment in the past, or if they were ineffective.

If you have thrush, as well as using OTC treatments, also try doing the following to ease the problem: wash your vaginal area using water and avoid using perfumed soaps, shower gels, vaginal deodorants, or douches; avoid using latex condoms, spermicidal creams and lubricants, if they cause irritation; and avoid wearing tight-fitting, synthetic clothes and wear cotton underwear and loose-fitting clothes, where possible.

It is important to remember that vaginal thrush is not a sexually transmitted infection (STI), says. Dr. Okeyo. “Your partner will not need to be tested or treated for the condition, unless they also have symptoms. However, if you are at all concerned about STI's, you should talk to your GP about being tested.”

Unfortunately, except doing the above, there is not much more you can do to ensure you stay Candida-free. “It is one of those things a woman has to put up with, but luckily there are treatments available to ease the discomfort.”

And who knows, with medical breakthroughs being made every day, maybe we will one day have a vaccine available against Candida. Now wouldn't that be something!

Issued on behalf of Netcare Rosebank Hospital by Martina Nicholson Associates