Thrush

Thrush is a yeast infection of the mucous membranes (the soft, pink coloured skin) of the vagina or penis.

In a healthy bowel and genital area many bacteria and small numbers of yeast cells (vaginal flora) usually exist. Yeast infections occur when there is a change in the normal balance of these organisms. This imbalance can be caused by many things, including medications or certain medical conditions. The most common healthy bacteria found in the genitals are Lactobacillus acidophilus. These bacteria may help prevent other organisms, such as yeast, from growing in excess and causing a vaginal infection. More than 85 percent of yeast infections are caused by a strain of yeast called Candida albicans.

Genital Candidiasis infections are very common in women, causing a condition that is commonly referred to as 'Thrush'. Genital Candidiasis is usually not considered a 'sexually transmitted disease', as it is generally caused by overgrowth of the Candida albicans fungi that normally inhabit a person's skin. Under certain circumstances, this fungus can divide excessively and the large numbers of fungal cells can produce the signs and symptoms of a Genital Candidiasis infection. Circumstances that may allow Candida cells to grow excessively include: diabetes mellitus, antibiotic use, corticosteroid drugs, HIV infection, low immunity, pregnancy (particularly in the third trimester) and use of oral contraceptives.

SIGNS AND SYMPTOMS
Women may experience:
• Irritation of the vulva (the entrance to the vagina and the surrounding area) and discharge from the vagina that may be a thick, whitish-coloured fluid.
• Inflammation of the vulva.
Men who have a Genital Candidiasis infection may not experience any symptoms, but some may experience:
• Irritation and soreness of the glans and prepuce (head of the penis).
• Inflammation of the glans and prepuce.
• White, cheesy material, pits or small, circular elevations on the penis.

TREATMENT OPTIONS
Always consult your Doctor for the diagnosis and treatment of Genital Candidiasis. Your Doctor will advise you on the latest treatments available for the treatment of this condition and also provide information on how to avoid re-infection. Genital Candidiasis in women (Thrush) is treated using topical antifungal creams (i.e. applied directly to the vagina). If the Thrush infection does not improve, then oral antifungal medications may be required. Genital Candidiasis in men is treated by washing the penis and surrounding skin with soap and water, drying with a clean towel and applying topical antifungal creams for 7 to 10 days. Vaginitis, Trichomoniasis and Thrush are difficult to distinguish on the basis of symptoms alone so it is important for a woman with vaginal symptoms to see her physician for an accurate diagnosis.

DIET HINTS
Certain dietary measures can be taken to minimise the growth of yeast in the bowel, which, in turn, reduces the likelihood of Thrush.
• Try to avoid foods high in simple carbohydrate such as refined sugars as Thrush thrives on sugar. These foods include fruit juices, sucrose, biscuits, cakes made from white flour and sugar, honey, white breads and pastries etc.
• Eat plain yoghurt, which contains live cultures of acidophilus. This yoghurt can also be applied directly to the vagina to relieve itchiness.
• Try to include foods high in fibre such as wholegrain cereals, fruits and vegetables, psyllium and oat bran.
• Try to limit (but not completely eliminate) foods high in carbohydrates such as potatoes, and fruits such as oranges, kiwi fruit, pineapple, lemons and limes, grapefruit, tomatoes. Re-introduce these foods slowly after about 1 month of treatment.
• Garlic is a natural antibiotic and can be included in the diet every day. It is best to have garlic at a separate time to acidophilus as the antibiotic activity of garlic may interfere with the acidophilus organism.

VITAMINS/MINERALS/HERBS
• Acidophilus bifidus supplementation may help as it feeds and promotes the growth of good bacteria.
• Garlic in cooking or capsule form, may be of benefit due to its anti-microbial and anti-fungal effect. Garlic is particularly effective against Candida albicans.
• Vitamin C and bioflavonoids promote the body's immunity and help protect the body against damaging toxins released from candida.
• Pau d'arco herb is thought to be an anti-bacterial and anti-fungal agent.
• Golden Seal herb may soothe and decrease inflammation of the mucous membranes. It also has an anti-bacterial action and is thought to help the immune system. Golden seal is also thought to help support the liver and digestive system.

NOTES
It is important to remember that thrush rarely occurs in post-menopausal women unless they are on hormone replacement therapy (HRT). This is because the candida species thrives in the presence of oestrogen. Post-menopausal women with vaginal irritation should immediately consult their medical practitioner.

PHARMACIST'S ADVICE
Ask your MedAux Pharmacist for advice.
1. Follow the Diet Hints
2. There are several antifungal vaginal creams available. These may be suggested by your Pharmacist to relieve Thrush. Ask advice on the use of these creams.
3. Avoid bathing too often and using perfumed soap as this can aggravate the condition and increase the risk of Thrush. Ask your Pharmacist about appropriate soaps and washes.
4. Wear loose cotton clothing and underwear to keep the genitals cool and well ventilated. Women prone to Thrush should avoid wearing pantyhose. Stockings are a better choice as these allow air circulation.
5. Increasing the acidity of the vagina may help to prevent Thrush. Washing with a preparation of water and vinegar may help to achieve this. Ask your Pharmacist about a gel which can be applied to the area as a preventative measure against Thrush.
6. After using the toilet always wipe from the vaginal area towards the anus. The Thrush organisms, which live outside the anus, are easily transferred to the vagina.
7. Make sure your sexual partner has been examined for Thrush to avoid re-infection.
8. Ensure that you rinse your mouth out and gargle with water after using an asthma puffer, look after your dentures properly and avoid smoking. (See the Thrush - Oral topic for further information).
9. If the dietary intake is inadequate, consider the nutritional supplements recommended in this topic.