Recurrent thrush diagnosis and treatment tips

Anti-fungal thrush treatment not working? Read this before you buy more cream or capsules!

What to do about your constantly itchy and sore vagina
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Are you one of the unlucky people who suffer from recurrent thrush? If you are constantly itchy and sore but anti-fungal medication doesn't seem to make a jot of difference, you may be starting to lose hope. But are yeast infections really the culprit?

Consultant sexual health physician Dr Nicola Smith explains how to diagnose and treat recurrent thrush and combat the most common causes of vulval discomfort:

What is recurrent thrush?

Thrush is a common yeast infection that affects women and men. Thrush is not classed as a sexually transmitted infection (STI) and is usually harmless, but it can be uncomfortable.

Recurrent or persistent thrush is defined as having at least four episodes of symptomatic thrush within a year, but it's important that you get a confirmed diagnosis before investing in over-the-counter anti-fungal medications to treat thrush.

Do you definitely have recurrent thrush?

Many women reach for over-the-counter vaginal thrush treatments as a matter of course to manage intimate itching and soreness, when thrush may not in fact be the culprit. Long-term use of anti-fungal medications can also have negative health consequences, so it is worth getting expert advice if symptoms persist.

This is because recurrent vaginal thrush is something that is often misdiagnosed by GPs, and women themselves, as the symptoms can mimic other vulval conditions such as vulval eczema, psoriasis and lichen schlerosus.

Recurrent vaginal thrush is often misdiagnosed as symptoms can mimic other vulval conditions.

'The most common thing I see in my clinic is patients presenting with persistent vulval itch and I'd say less than 5 per cent of those women actually have recurrent thrush,' reveals Dr Smith, 'Contact allergy is much more common than people realise, particularly from wet wipes, bubble baths and certain lubricants.'



The dangers of thrush misdiagnosis

Wait to get a confirmed diagnosis before investing in over-the-counter anti-fungal medications to treat thrush, as these can irritate you further.

'By avoiding the trigger and with correct treatment many women are better within weeks,' says Dr Smith. 'Don't do anything drastic like start on a restrictive "anti-candida" diet or use thrush treatments until you have a confirmed diagnosis. Although topical anti-fungals may offer some relief of symptoms because they are emollients, for some women they may irritate already sensitised vulval skin, and oral fluconazole is a systemic drug which can have consequences for the liver if overused.'

If it turns out you do in fact suffer from recurrent thrush, this requires specialist management with the help of your GP. 'Recurrent thrush when it does occur can be a complex and complicated issue which needs specialist management, including a liver function test if oral anti-fungals are being used regularly,' advises Dr Smith.



Diagnosing recurrent thrush

If you keep getting symptoms which you think are thrush, it is crucial to get a correct diagnosis rather than hoping over-the-counter treatments will clear things up.

'Go to your local sexual health clinic when you are symptomatic and get them to look down the microscope at a sample to see if you actually have active candidiasis,' advises Dr Smith.

If you have persistent genital itching ask your GP for a referral to a specialist vulval clinic for a definitive diagnosis.

'A recurrent thrush diagnosis should always be based on repeated microscopy that picks up active candida, it should never be made on a swab culture alone, because this can be misleading. Many women have naturally occurring candida in their vaginas which doesn't cause problems yet can be grown from a swab culture.'

'The clinic can also do a full screening for other sexual health conditions that may be relevant,' she adds. 'If you have persistent genital itching you need to ask your GP for a referral to a specialist vulval clinic for a definitive diagnosis; you may need specific treatment that needs careful management by a consultant.'



Common causes of vulval discomfort

If you're constantly uncomfortable, once you've officially ruled our recurrent thrush there are a number of lifestyle tips you can try to minimise itching and vulval discomfort:

• Opt for white cotton underwear

Silk or cotton underwear is often advocated as a 'breathable' and a safer bet than synthetic alternatives, but it turns out that colour is important too.

'A lot of people don't realise they are allergic to fabric dye, so go for white cotton rather than coloured,' says Dr Smith. 'Avoid g-strings and daily use of panty liners. If you do need to use a liner or pad (for periods or urinary incontinence) smear on a barrier cream and use products which are not chlorine bleached!'

• Invest in some barrier cream

If you are a keen swimmer or gym-goer opt for a bland, un-perfumed barrier cream such as emulsifying ointment (available to buy from the chemist) to protect your vulva.

'Women who go swimming regularly are at risk of vulval dermatitis, particularly from chlorinated pools. Smear on a barrier cream first and get your swimming costume off as soon as possible afterwards,' says Dr Smith. 'Just wash once during the day, after you exercise, no more than that or you risk washing away the protective vaginal microflora.'

• Use emulsifying ointment to protect your skin

'When you wash, use plain water or an emulsifier - and nothing else!' recommends Dr Smith. If you're prone to genital itch, before urinating or opening your bowels apply some emulsifying ointment to protect your skin – avoid rubbing with dry toilet paper, use extra emulsifier smeared on toilet paper as a wet wipe.'

• Try natural lubricants

If you suffer from vulval discomfort, opt for natural lubricants, and not just in the bedroom.

'Lubricants are a great idea if you get itchy, not just during sex but massage on whenever you feel uncomfortable,' suggests Dr Smith. 'Oil-based lubricants without additives are great, but can damage latex so opt for polyisoprene or sensoprene condoms instead.'

'Avoid flavoured condoms, glitter, scented products, food items and over zealous waxing and shaving!' she adds. 'Keep it natural and your vulva will thank you.'



Last updated: 07-10-19

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