Pharmacy Practice IV

Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.

Thrush // Page 1 of 6

Thrush / Vaginitis / Candidiasis / Yeast Infection

1. Fungal infection (mycosis) of any of the Candida species, especially Candida albicans. Others
are Candida glabrata (more resistant), etc. These fungi are normally present in the body
without any problem but their overgrowth leads to thrush
2. Since Candida fungus thrives in warm, moist and dark places, exposed areas with these
conditions such as the mouth, skin folds, armpits and vaginas are more vulnerable
3. Women have thrush at least once during their lives
4. Many have more than one episode - recurrent thrush
5. Can affect a womans sex life and self-image
6. May be a sign of a more serious health problem


Contributing factors

Level of yeast kept low by friendly bacteria. When this balance is disrupted the yeast is allowed
to grow unchecked.

1. Pregnancy
a. Many women have their first episode of thrush while they are pregnant
b. Hormone levels change dramatically during pregnancy and this creates high levels of sugars in vaginal
secretions
c. If the extra sugars arent broken down quickly, candida will use them to grow

2. Diabetes
a. Women with diabetes are more likely to get thrush than are women who do not have diabetes
b. Diabetes increases blood sugar levels, which may increase the sugar in vaginal secretions
c. Diabetic women also tend to have high sugar levels in their urine, and this may contribute to thrush by
feeding yeast in the genital area just outside of the vagina

3. Sex
a. Vaginal thrush is not a sexually transmitted infection (STI) if youve never had sex, you can still get
thrush but sex may play a role in the development of thrush
b. Penetrative sex can irritate the vagina, particularly when there is little lubrication
c. Semen may change the acidity of the vagina which can then lead to thrush
d. Masturbation has not been linked to thrush
e. Thrush can be, but is not always, passed on to a partner during sex
f. Most women get thrush as due to their own internal changes or circumstances, not through sexual contact
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Thrush // Page 2 of 6

g. Men are more likely than women to get thrush through sex
4. Diet
a. Certain foods may have an impact on thrush - sugar, dairy products, coffee and tea contribute to thrush
by increasing urinary sugar

5. Weakened or undeveloped immune system
a. HIV/AIDS, cancer treatments
b. Steroids
c. Stress
d. Nutrient deficiency

6. Antibiotic use
a. Antibiotics kill friendly bacteria which would otherwise help maintain Candida at safe levels, thus allowing
the fungus to overgrow. Without good bacteria lactobacilli, the balance in the vagina is disrupted and
Candida can take over
b. Your body may be run down. If you are taking antibiotics, your body is likely to be run down or weak from
an illness. While your body is busy fighting another infection, yeast may seize the opportunity to multiply

7. Menstrual cycle
a. Vaginal secretions change throughout the menstrual cycle
b. While the vagina can usually deal with these slight changes, some women tend to get thrush just before or
after their periods
c. Menstrual blood can change the acidity of the vagina, and as a result, some women get thrush during their
periods

8. The contraceptive pills, hormone replacement therapy and infertility treatments
a. The pills affect hormones that, amongst other things, can affect a womans ability to metabolise (process)
sugar
b. Yeast feeds on sugar, and if there is extra sugar in the body, yeast will use it to grow
c. The contraceptive pills available now are less disruptive to the body than they used to be. Because of this,
it is widely believed that taking the pills no longer increases a womans risk of thrush
d. Some studies, however, suggest that women who use the pills may still be more likely to develop thrush,
and have recurrent thrush, than woman who do not use the pills

9. Intra-uterine device (IUD)
a. Some of the side effects associated with the IUD, such as heavy bleeding and bleeding between periods,
also play a role in the development of thrush
b. Women who use an IUD may also have an increased risk of developing vaginal and uterine infections,
which can lead to thrush

10. External Irritants
a. Anything that changes the natural acidity (pH) of the vagina, or damages the tissues in and around the
vagina, may lead to thrush
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Thrush // Page 3 of 6

b. Perfumed soaps, vaginal deodorants, douches, disinfectants and scented bubble baths can all irritate or
damage the delicate tissues of the vagina and vulva
c. Whether you use perfumed soaps or not, scrubbing, excessive washing or rubbing hard with a towel may
do enough damage to lead to thrush
d. Tampons and towels may also play a part in creating the right environment for thrush. If a tampon is left
in too long (more than about 12 hours), it can dry out the vagina, change the pH balance and trigger
thrush. Unchanged towels can create a moist, warm environment around the vulva, and yeast thrives
under these conditions

11. Poor circulation
a. Tight clothing, tight trousers, leggings, synthetic knickers or tights prevent air from circulating and can
create a warm, moist place for thrush to develop


Symptoms

1. Severe itching, burning, and soreness - scratching will only make the problem worse
2. Irritation and swelling of the vagina or vulva - Thrush irritates the delicate tissue of the
vagina and genital area, making it sore, swollen and red. As a result, it may be painful to
urinate (urine will sting the inflamed tissue). It may also be painful to have sex. In some
cases, anything that touches or rubs the area, including sitting and walking, can be painful
3. Whitish or whitish-gray discharge, often with a curd-like appearance with yeast-smelling
discharge. Discharge caused by thrush is usually (but not always) white and thicker than a
womans regular discharge. The typical discharge linked to thrush is yoghurt-like in
appearance and smells strongly of yeast. Some women, however, have a watery or mild-
smelling discharge. The amount can also vary from a little to a lot. Many women mistake the
symptoms of the more common bacterial infection for a yeast infection


Diagnosis

1. Microscopic examination
a. A scraping or swab of the affected area is placed on a microscope slide
b. A single drop of 10% potassium hydroxide (KOH) solution is then also placed on the slide
c. The KOH dissolves the skin cells but leaves the Candida untouched, so that when the slide is viewed under
a microscope, the hyphae and pseudo spores of Candida are visible
d. Their presence in large numbers strongly suggests a yeast infection

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Thrush // Page 4 of 6

2. Culturing
a. A sterile swab is rubbed on the infected skin surface
b. The swab is then rubbed across a culture medium
c. The medium is incubated for several days, during which time colonies of yeast and/or bacteria develop
d. The characteristics of the colonies provide a presumptive diagnosis of the organism causing symptoms

3. Self-diagnose
a. Particularly if had thrush before
b. However, many women may be misdiagnosing themselves
c. Some symptoms of thrush are common to other vaginal infections so it is important to be sure that you
have thrush, and not something else, before you start treatment
d. The wrong treatment can make an infection worse and using thrush treatments when you dont need them
can help the yeast build up a resistance to treatment

Infection Symptoms
Thrush
White discharge, often thick but sometimes watery. Discharge may
smell yeasty. Itching and burning around genital area. Can also be
swollen and red
Bacterial Vaginosis (BV)
Greyish-white discharge with a strong fishy smell. Burning, soreness
and sometimes itching around the genital area, but no redness or
swelling
Trichomoniasis
Thin, frothy discharge (white or greenish yellow) with a very strong
fishy smell. Vaginal itching and soreness


Medicinal treatment

1. Antimycotics (antifungal drugs). Topical preparations and pessaries are non-prescription
drugs while the oral preparations are prescription-only medicines:
a. Clotrimazole (cream, pessary)
b. Nystatin (cream, pessary) more broad spectrum, treatment takes longer
c. Miconzole Daktarin (cream)
d. Ketoconazole Nizoral (cream and oral)
e. Itraconazaole Sporanox (oral)
f. Fluconazole Diflucan (oral) single dose is adequate

2. Antifungal + corticosteroid such as hydrocortisone to control itchiness

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Thrush // Page 5 of 6

3. Pessaries and creams
a. Work directly at the site of infection in the vagina and on the outer lips of the vagina
b. Pessaries are bullet-shaped tablets that can be either hard or waxy
c. Need to be pushed high into your vagina with finger or an applicator
d. Pessaries and creams can be messy
melt and leak out into pants
best to insert them at night just bed
may also use a panty liner, as some treatments are coloured and can stain
e. Length of treatment
varies with different brands of pessaries and creams
may last one day, three days, six days or 14 days
dont stop treatment if get period important to complete the full course of treatment

4. Oral treatment is more convenient but more likely to cause side effects (nausea, diarrhoea,
abdominal pain, dizziness or skin rash) and should not be used if you are pregnant,
breastfeeding or taking certain medication (antihistamine loratadine)


Non-medicinal measures

1. Douches (controversial)
a. lactic acid wash
b. helps maintain the natural pH balance in the vaginal area
c. prevents yeast from taking hold

2. Dietary changes
a. May be effective for preventing or during a Candida infection
b. Due to its requirement for readily fermentable carbon sources, such as mono- or dimeric sugars (e.g.,
sucrose, glucose, lactose) and starch, avoiding foods that contain these nutrients in high abundance may
help to prevent excessive Candida growth

3. Herbs, etc
a. Calendula
b. Garlic
c. Tea tree oil
d. Vinegar

4. After toilet
a. Wash thoroughly or wipe from front to back after going to the toilet
b. Candida in the bowel can infect the vagina and cause thrush, but wiping from the front will help reduce the
chance of this happening
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Thrush // Page 6 of 6


5. Take yoghurt (friendly bacteria)

6. Wear cotton underpants and clothes that arent too tight. This will prevent the area from
becoming too moist and warm

7. Do not leave tampons, contraceptive sponges, cervical caps or diaphragms in place too long

8. If you are taking antibiotics, and are prone to thrush, consider using a thrush treatment at
the same time. Remember that using a treatment too often when it is not necessary may
make yeast resistant

9. Avoid using perfumed soaps, bubble baths or vaginal deodorants. The chemicals in these
products are too harsh for the delicate tissue and pH balance of the vaginal area


Refer

1. Never had thrush before (first time)

2. Pregnant
a. Pessaries and creams are not well absorbed into the bodys circulation and are therefore unlikely to affect
a developing fetus
b. But there has been little research into their use during pregnancy

3. Current treatment not working

4. Recurrent thrush
a. May be a symptom of a larger health issue (diabetes, HIV, dermatitis, other infections, etc)
b. Yeast may have taken over another part of the body, such as the intestines - vaginal pessaries and creams
will not be able to treat the whole problem; oral tablets are often prescribed