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Clinical thrush

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VOL: 96, ISSUE: 42, PAGE NO: 10

Anita Weston, MSc, RGN, CertEd, is head of subject for sexual health, Wolfson Institute of Health Sciences, Thames Valley University, London

Vaginal thrush is caused by Candida albicans, a yeast that lives on the skin and in the mouth, throat, vagina and intestinal tract, usually without any problems. Occasionally conditions change and it multiplies rapidly, causing symptoms (Greer, 1998). This is known as clinical thrush or candidiasis.

Vaginal thrush is caused by Candida albicans, a yeast that lives on the skin and in the mouth, throat, vagina and intestinal tract, usually without any problems. Occasionally conditions change and it multiplies rapidly, causing symptoms (Greer, 1998). This is known as clinical thrush or candidiasis.

Thrush causes great discomfort and inconvenience to women, accounting for most complaints of vulvovaginal itching and irritation. It is one of the most common disorders seen by GPs (Hammill and Kaufman, 1990). It also presents in men and, although it is not strictly a sexually transmitted infection, it seems to be exacerbated by sexual intercourse.

How do you get thrush?
Anyone - male or female, young or old, sexually active or celibate - can get thrush. For C. albicans to proliferate there has to be a change in the vaginal environment, which normally has a pH of 4.5 and a bacterial flora that includes lactobacilli. Both of these factors inhibit fungal growth.

The following factors may change the vaginal environment, encouraging the development of thrush:

- Pregnancy;

- Taking certain antibiotics;

- Immunosuppression;

- Wearing tight clothing, especially man-made fibres such as nylon;

- The use of tampons;

- The use of an intrauterine contraceptive device;

- Stress;

- Diabetes;

- Reduced lubrication;

- An excess intake of dairy products or sucrose;

- The use of vaginal deodorant, perfumed soap and bubble bath;

- Sex with someone who has thrush.

What are the symptoms?
Men who are not circumcised are more likely to develop thrush. In both men and women, one or more of the symptoms listed may be present.

Women:

- Itching, redness and soreness around the vulva, inside the vagina or around the anus;

- A thick, white vaginal discharge;

- Oedema in the vulval area;

- Dysuria;

- Dyspareunia.

Men:

- Irritation, itching or burning under the foreskin or on the tip of the penis;

- A red rash or red patches under the foreskin or on the tip of the penis;

- Difficulty in retracting the foreskin;

- Dysuria;

- A thick discharge under the foreskin;

- A slight urethral discharge.

Tests and treatment
Patients should see their GP or attend a genitourinary medicine clinic, which will test for thrush and carry out a full sexual health screening.

Testing for thrush involves an examination of the genital area. Women are usually also given an internal pelvic examination.

Using a small soft swab, samples will then be taken from any site where thrush may have developed. For men, this may mean under the foreskin. A urine sample may also be taken.

The most common treatment is an antifungal agent, such as clotrimazole. This is usually prescribed as a combination of vaginal pessaries and topical cream for use over three nights, but a one-off clotrimazole 500mg pessary may also be given.

Oral fluconazole 200mg may be prescribed as an immediate dose, but this is expensive and is not recommended for pregnant women.

Men are treated with topical clotrimazole cream twice a day for three days.

Both fluconazole and clotrimazole are available as over-the-counter treatments, but self-diagnosis and treatment are not recommended. However, patients with recurrent thrush may recognise the symptoms and choose to treat themselves.

If a patient has been diagnosed with thrush, his or her sexual partner must be treated concurrently to avoid repeated cross-infection when sexual activity resumes.

Recurrent episodes of thrush may require medical investigation.

Conclusion
Thrush can result in painful, sore skin and vulval itching in women and uncomfortable swelling of the foreskin in men.

Although it is more common in women than in men, treatment is generally straightforward. It should not, however, be considered a minor problem as it can cause great discomfort and be extremely distressing for patients.

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