Thrush (Candidiasis)

Candidiasis, commonly called yeast infection or thrush, is a fungal infection caused by any of the Candida species, of which Candida albicans is the most common. The name thrush can mean infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases. Infections of skin and mucosal membranes by Candida cause local inflammation and discomfort and are common.

Candidiasis is a very common cause of vaginal irritation, or vaginitis, and can also occur on the male genitals.

Candida yeasts are usually present in most people, but uncontrolled multiplication resulting in irritating symptoms is kept in balance by other naturally occurring microorganisms, e.g., bacteria living with the yeasts in the same locations, and by the human immune system.

In a study of 1009 women in New Zealand, Candida albicans was isolated from the vaginas of 19% of apparently healthy women. Carriers experienced few or no symptoms. However, external use of irritants (such as some detergents or douches) or internal disturbances (hormonal or physiological) can alter the normal flora, constituting lactic acid bacteria, such as lactobacilli, and an overgrowth of yeast can result in noticeable symptoms. Pregnancy, the use of oral contraceptives, and using lubricants containing glycerin have been found to be related to yeast infections. Diabetes mellitus and the use of antibiotics are also linked to an increased incidence of yeast infections. Diet has been found to be the cause in some animals. Hormone Replacement Therapy and infertility treatments may also be predisposing factors.

A weakened or undeveloped immune system or metabolic illnesses, such as diabetes may predispose individuals to thrush. Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida species. In extreme cases, these superficial infections of the skin or mucous membranes may enter into the bloodstream and cause systemic Candida infections.

Antibiotic and steroid use are the most common reason for yeast overgrowth. The former kills the bacteria which would otherwise help maintain Candida at safe levels, thus allowing the fungus to overgrow.

Since the Candida fungus thrives in warm, moist and dark places, exposed areas with these conditions such as the mouth (oral thrush, daktarin oral gel), skin folds (athlete's foot Lamisil, or jock itch Lamisil), armpits (canesten cream) and vaginas are most vulnerable.

In penile candidiasis, (Treat with Diflucan capsule or Fluconazole capsule or Canesten Thrush cream) the causes include sexual intercourse with an infected party, low immunity, antibiotics and diabetes. However, male yeast infection is less common and the risk of getting it is only a fraction of that in women. However, yeast infection on the penis from direct contact via sexual intercourse with an infected woman is uncommon.

Symptoms of thrush:

Symptoms include severe itching, burning, and soreness, irritation of the vagina and/or vulva, and a whitish or whitish-gray discharge, often with a curd-like appearance.

Many women mistake the symptoms of the more common bacterial vaginosis for a thrush infection. In a 2002 study published in the Journal of Obstetrics and Gynecology, only 33 percent of women who were self treating for a thrush infection actually had a thrush infection. Instead they had either bacterial vaginosis or a mixed-type infection.

For men, symptoms include red patchy sores near the head of the penis or on the foreskin, severe itching and/or a burning sensation. Candidiasis of the penis can also have a white discharge, although uncommon. However, having no symptoms at all is common and usually, a more severe form of the symptoms may emerge later.

It is 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.

Treatments of thrush:

Thrush is usually treated with antimycotics. The antifungal drugs commonly used to treat thrush over the counter are topical clotrimazole and oral fluconazole.

Clotrimazole, is a very effective treatment available in different formulations. Applied as a cream (clotrimazole 1% cream, Canesten 1% cream) it is instantly soothing and can be used at the same time as the oral treatment. (Fluconazole capsule, diflucan capsule or canesten capsule) The higher strength cream (canesten 2% cream) will treat the infection more quickly but is more expensive. Combination products offer a 2 in 1 of the soothing cream and a pessary/capsule. (Pessary + 2% cream, oral Capsule + 2% cream)

Clotrimazole is also available as a pessary which is inserted into the vagina. A single 500mg pessary (clotrimazole, Canesten) which is applied once at night. Or 3 x 200ng pessaries which are applied at night for 3 nights (Canesten)

The treatments by mouth consist of a one-time dose of fluconazole (generic)(or the brand names of Diflucan 150-mg or Canesten). This has been reported as being 90% effective in treating a vaginal thrush infection. This dose is only effective for vaginal or penile thrush infections, and thrush infections elsewhere on the body may require different treatments. 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.

Babies with nappy rash should have their nappy 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 spp. 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.

The following measures are advisable for keeping the vulva and vagina healthy:

Washing once a day or so with water but without soap, since soap disturbs the natural pH balance of the vagina. Other measures are rarely necessary or advisable. 

After using the toilet, wipe from the front toward the back to avoid introducing bacteria from the anal area into the vulva. Use non-perfumed, undyed toilet paper.
Drink plenty of water and pass water frequently and as soon as possible when you feel the need, to help flush bacteria out of the urinary tract and avoid urinary tract infections. For the same reason, try to urinate before and after sex.
Change out of a wet swimsuit or other wet clothes as soon as possible.
Avoid fragrances, colours, and "deodorants" in products that contact the vulva/vagina: sanitary towels, tampons, toilet paper. Some women who are sensitive to these substances should also avoid bubble baths and some fabric detergents and softeners.
Avoid wearing leather trousers, tight jeans, underwear made of nylon or other synthetic fabrics, or tights.
Use condoms, practice safer sex, know your sex partner(s), ask sex partners to practice basic hygiene of their genitals. Use artificial lubrication during the intercourse if the amount naturally produced is not enough. 

Symtoms which need referral to your doctor:

Recurring thrush infections.

Odourous discharge.

If you or your partner have been exposed to a sexually transmitted disease.

Signs of blood

Pain or burning on passing urine

Abnormal discharge

Sores, ulcers or blisters

Abdominal or back pain

For much more information click Thrush or go to NHSDirect at www.nhs.uk 

This page was last updated: Monday 25 September, 2017