Vaginal Candidiasis.

 

Definition:

Vaginal Candidasis (or thrush) is an infection caused by Candida albicans. This is an organism usually found in the healthy vagina, but if there is a change in the pH levels of the vagina it can disturb the balance between the candida and other organisms, which allows the candida to flourish.

 

 

Causes:

Antibiotics can alter levels of bacteria in the vagina, allowing the candida to over develop.

 

Hormonal changes can also contribute, for example from taking the Pill or in pregnancy.

 

Wearing tight or synthetic clothing- these encourage the warm, moist conditions that candida thrive in.

 

Damage to vaginal tissue, which can firsly occur during sexual intercourse due to lack of lubrication or alternatively from overly vigorous washing.

 

 

Presentation:

Itching and soreness around the outside of the vagina, which may get worse at nightime.

 

Discharge from the vagina may be white and curd-like, and is odourless.

 

Patients often feel a stinging sensation when passing urine.

 

Sometimes, they may also feel pain during intercourse.

 

 

Differential Diagnosis:

Check whether there has been any change in urinary frequency- this may be indicative of cystitis.

 

If the patient is having regular attacks (more than two in the last six months) they should be referred to their GP as there may be another reason for their symptoms.

 

If the patient is passing any blood in the urine then they should also be referred, as this could potentially be a sign of a more serious cause.

 

 

Treatment:

An antifungal treatment is most common, such as clotrimazole. A cream is often used (Care

Clotrimazole Cream, 1%), or combination packs of a pessary and cream are also available

(Canesten Soft Gel Pessary Combi). The pessary and internal cream will treat the internal

infection, whilst the external cream will soothe the external itch.

 

The internal pessary or vaginal cream should be used at night, before going to bed.

 

The external topical cream should be applied to the external areas of the genitals twice a day

for about three days to ensure success of treatment.

 

The other treatment option is a single oral fluconazole capsule (Canesten oral capsule), which

some patients may find more convenient and less invasive.

 

It may take up to 7 days for complete relief of symptoms, any longer and a patient should see

their GP.

 

HOW TO INSERT A PESSARY:
Lie on the back with the knees bent up. Use the applicator provided in the pack to insert the

pessary high up into the vagina. It is not recommended to use the pessary during a period as

the pessary may be washed out. When using the product do not use any spermicides, tampons,

intravaginal douches or any other vaginal products.

 

 

Self Help Advice:

Avoid tight fitting and synthetic clothing.

 

Do not use perfumed soaps, vaginal deodorants etc.

 

Wipe from front to back after using the toilet.

 

Wash the genital area daily with a fragrance free product.

 

Avoid antiseptics.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Sample Question:

Which one of the following is a typical symptom of vaginal thrush?

 

A a foul smelling vaginal discharge

B intermenstrual bleeding

C lower abdominal pain

D pus in the urine

E vaginal itching

 

Answers to all sample questions can be found by following the link under the Test Yourself tab.