Vaginal thrush - a real problem for some women

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For some women this is a real bore. They seem particularly prone to recurrent infections. Thrush can be sexually acquired but the majority of cases are not. The commonest organism is candida albicans, but other candida species may also be present. Yeasts are constantly present on our skin - but some women, particularly just before a period, are prone to infection.

What seems to happen in the longer term is that infection is replaced by allergy. Indeed allergy reactions are identical to infection responses - it is just that allergy starts at a lower threshold. This is particularly troublesome when one is dealing with a fairly benign bug which should otherwise cause little problem - it is difficult for the immune system to get the balance right! So a woman could have all the classical symptoms of thrush but be told that swabs are negative - they are not - it is simply there are insufficient yeasts to justify a diagnosis of infection.

Clinical picture

Classically there is a thick "cheesy" vaginal discharge with itching vulva and vagina and sometimes slightly runny secretions. Some women just present with soreness.

The classic predisposing factors of thrush are:

  • The Pill and HRT
  • The coil - many IUCDs (coils) contain hormones
  • Following a course of antibiotics
  • High sugar diet (or uncontrolled diabetes)
  • Wrong bugs in the gut - see Probiotics.

"Sugar's the bugger" said one of my patients! Yeasts can only exist on simple sugars. If there is a high level of sugar in the blood, there will be a high level in the tissues and this encourages growth of yeast. The interesting thing is that yeast seem to have the ability to cause sugar craving, thereby ensuring their own survival. A possible reason is that vaginal yeast infections may be accompanied by yeast overgrowth in the gut. This will ferment sugar to alcohol which has the effect of lowering blood sugar levels and this triggers sugar craving. See Hypoglycaemia Most women with recurrent thrush are not diabetic, (they are hypoglycaemic which is a pre-diabetic condition) but this should be checked for with multistix urine testing.

Very often, tests for candida are negative. This occurs when allergy to yeast occurs and the vagina acts as a target organ. Either yeasts are present but in such low amounts that no infection can be detected, or the vagina is reacting allergically to yeasts elsewhere in the body, eg the gut. In this event topical antifungals are ineffective. See Gut dysbiosis and Irritable Bladder Syndrome or Allergic Bladder.

The Pill or HRT should be stopped, and the coil, if present, removed.

Antibiotics are a problem because they kill the good bugs in the vagina and this allows the bad bugs (ie thrush) to grow and proliferate. With antibiotics, antifungal cover should be given. This means either pessaries or tablets need to be used during and after the course of antibiotics. Some women are helped by recolonising the vagina with good bugs by using live cultures e.g. Kefir). I am not aware of any preparations on the market of probiotics in a pessary form but if available they would be welcomed!

Drug treatment of thrush

This amounts to capsules or pessaries or creams or a combination. Most are available over the counter. My experience is that most treatments are not given for long enough. I usually used pessaries and creams first and if the bug is resistant, move on to the capsules. Nystatin is not absorbed into the blood stream and therefore is ineffective by mouth.

Pessaries and creams - nystatin, imidazoles (such as clotimazole, econazole, isoconazole and miconazole) are all reasonably effective. They should be used for at least one week, often 2 weeks. The pessary should be placed high in the vagina, creams over the vulva (the outside bits).

Capsules of fluconazole (Diflucan) or itraconazole (Sporanox) are effective but should not be used if there is any possibility of pregnancy because they are toxic to the unborn child. Diflucan is available over the counter as a single dose treatment of 150mgs, but I find often one or two weeks treatment of 50-100mgs is necessary for resistant cases. Some women seem to need recurrent courses.

Preparations to acidify the vagina can also be helpful as this creates the right environment for the good bugs to flourish. Aci-gel used to be available but is no longer manufactured. At present I know of no alternative.

Some women with these problems also suffer from fatigue and this my be due to the fermenting gut. See Fermentation in the gut and CFS

However despite the above regimes, some women still get recurrent symptoms. Sometimes it is because they are allergic.

Is this allergy?

Allergy is the great mimic and can produce almost any symptom. Some women have chronic symptoms not because they have infection but because the vagina is acting as an allergic target organ. If you looked at a hay fever sufferer with his streaming eyes, sneezing, runny nose and raised temperature you might conclude he had a cold. Similarly a woman with inflammation of the vagina and discharge may be reacting allergically - the commonest allergen is yeast.

With candida problems, different people need different levels of intervention to get a result. There is a progression of treatments to go through. Start with:

  1. Take standard recommendations of nutritional supplements.
  2. Low sugar diet.
  3. Low carbohydrate diet.
  4. Low CHO, yeast free diet.
  5. High dose DIY probiotics.
  6. Herbal antifungals eg pau d'arco tea, garlic, oregano complex, grapefruit seed extract and caprylic acid.
  7. Topical drug perparations eg, nystatin, itraconazole.
  8. Single systemic drug prepration eg itraconazole, fluconazole.
  9. Combination of drugs and herbs.
  10. Desensitisation - see Enzyme Potentiated Desensitisation (EPD).

For some women, there are reactions to atmospheric moulds or yeasts. The connection is often made when symptoms resolve whilst on holiday in a hot dry or cold dry climate, or whilst on the coast where onshore winds are free from moulds. In this event, consider purchasing an air filter - see The Healthy House Ltd.

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