Other names :
Candidiasis, moniliasis.

Introduction :
Fungal infection by Candida albicans.

Types :
Thrush is most common in the vagina, but may also occur in the mouth, around the anus, and rarely in the nose.

Cause :
Thrush is a fungal infection caused by Candida albicans. It is a distant cousin to the fungus that can grow on rotting food. Candida can cause infections in many different areas, but the most common are the mouth and vagina. The mouth infections usually occur in babies, but it is the vaginal form that causes the greatest problem. Candida albicans normally lives in the gut where it causes little or no trouble. Usually when it comes out on to the skin around the anus, it dies off; but if that skin is warm, moist and irritated, it can grow and spread forward to the lips of the vagina (the vulva). A warm climate and the aggravating factors listed below, give the area between a woman’s legs the right degree of warmth, moisture and irritation to make the spread of the fungus relatively easy. Antibiotics aggravate the problem because, as well as killing infecting bacteria, they can kill off the good bacteria in the gut which normally keep the number of fungi under control. Entry of the fungus into the vagina from the skin outside is aided by the mechanical action of sex, and the alteration in the acidity of the vagina caused by the contraceptive pill.

Incidence :
Almost every woman catches thrush at some time in her life.

Prevention :
Tight jeans, panty hose, the contraceptive pill, nylon bathers, antibiotics and sex. These are the common aggravating factors involved in catching the modern woman’s curse of vaginal thrush. You can prevent infections by wearing loose cotton panties (or no panties at all at home and when socially acceptable), drying the genital area carefully after swimming or showering, avoiding tight clothing, wiping from front to back after going to the toilet and not using tampons when an infection is likely.

Investigations :
No investigation is normally necessary, as the diagnosis is obvious when a woman is examined, but if there is any doubt, a swab can be taken from the affected area and sent to a laboratory for culture and identification.

Course :
Once established, thrush causes an unpleasant white vaginal discharge, intense itching of the vulva and surrounding skin, and often inflammation of the urine opening so that passing urine causes discomfort. The almost irresistible, but socially unacceptable itch is what drives most patients to the doctor.

Treatment :
The treatment of vaginal thrush revolves around antifungal vaginal pessaries, vaginal creams and an expensive oral tablet (Diflucan -see Medication Table). These can give rapid relief, and are given in a course that can vary from one to ten days depending on the severity of the infection and the method of treatment used. Unfortunately, many women have repeated attacks, and this is due to inadequate treatment, contamination from the gut, or reinfection from their sex partner. The husband/boyfriend must also be treated with a cream, because although he may show no signs of the infection, it may be present under his foreskin, and he can give the thrush back to the woman after she has been successfully treated.

Diet :
There is no evidence that any particular diet aggravates, or treats, thrush effectively.

Complications :
Thrush rarely causes serious medical problems, but because of it troublesome nature, it should always be treated promptly and effectively

Outcome :
Most thrush infections can be cured quickly, but recurrences are common.

Related conditions :
Fungal Infections.