Candidiasis (Thrush)

Original article by Tom Leach | Last updated on 28/6/2014
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The second most common cause of pathological vaginal discharge, it is not usually sexually transmitted, and is instead the result of fungal overgrowth.
 

Epidemiology

  • 95% of cases the result of Candida albicans
  • 5% of cases due to Candida Glabrata – which is more difficult to treat
 

Aetiology

  • Pregnancy
  • Steroids
  • Antibiotics
  • Immunodeficiency
  • Diabetes
    • ALWAYS perform urine dipstick on a female patient presenting with thrush
  • Not usually sexually transmitted – but can be – check that the partner is not affected before treatment to avoid re-infection.
 

Presentation

  • A white discharge, often described as clotted cream / cottage cheese, usually non-offensive
  • Itchy and sore vulvar area
  • The partner is usually asymptomatic, although sometimes candidal infection can cause balanitis in men
 

Investigations

  • Speculum and inspection
  • Vulval and vaginal appearance:
    • Sore, red
    • Vaginal may be hyperaemic (red) and oedematous
  • Vaginal pH - <4.5 (not always)
  • Triple swabs and smear (chlamydia, gonorrhoea, and a ‘general’ swab for culture)
    • Microscopy will show budding yeast spores
    • Culture to rule out other causes
 

Treatment

  • Topical
    • Clotrimazole – can be given as a cream and/or pessary. Similar cure rates to a single oral dose of fluconazole
  • Oral
    • Fluconazole – single oral dose – 150mg
  • If infective agent is C. Galbratamore difficult to treat. Try:
    • Topical Nystatin
    • Oral Imidazole – 7-14 days
  • BREASTFEEDING / PREGNANCYUSE TOPICAL TREATMENTS ONLY
  • Recurrent infection – may require maintenance dose