Thrush and Other Vaginal Infections

The three most common vaginal infections in women are bacterial vaginosis, candidiasis (also known as thrush) and trichomoniasis. While candidiasis is often considered by women to be responsible for most vaginal infections, bacterial vaginosis is also very common.

The most typical symptom of a vaginal infection is an abnormal vaginal discharge. Recognising what is ‘abnormal’, however, is sometimes difficult for women as vaginal discharge differs in consistency and amount during different phases of the menstrual cycle and different life stages. Normal vaginal discharge can range from clear and slippery, like raw egg white (around the time of ovulation) to sticky and white or cloudy (just before and after a period). The discharge can have an odour but it is generally not unpleasant. Women who take the oral contraceptive pill may experience an increase in vaginal discharge while menopausal women commonly report a reduction.

Bacterial vaginosis

Bacterial vaginosis (BV), previously referred to as Gardnerella, is caused by an overgrowth in bacteria which occur naturally in the vagina. BV is, therefore, not actually an infection as such, but rather an imbalance. Normally, the bacteria which cause BV are kept in check by the presence of ‘good’ bacteria, lactobacilli, which keep the vagina acidic.

Smoking increases the risk of BV as does douching (rinsing the vagina out with water or a solution). While it is unclear if BV is actually sexually transmitted, it is associated with sexual activity. That is, sexual intercourse, particularly with a new partner or multiple partners, appears to increase a woman’s risk of BV. It is thought that sexual intercourse might result in a decrease in the numbers of the good bacteria, lactobacilli (1)

BV is associated with pelvic inflammatory disease (PID) and can increase the risk of miscarriage and preterm delivery (2).

Symptoms
Many women with BV will be asymptomatic (experience no symptoms). If present, symptoms can include:

• Fishy smelling vaginal discharge (smell often worse at menstruation or after unprotected vaginal intercourse)
• Grey or white vaginal discharge, thin or watery in consistency
• Vaginal itching (although not particularly common)

Diagnosis and treatment

Women who suspect they may have a vaginal infection should visit their doctor. If possible, women should abstain from vaginal intercourse for at least 24 hours prior to the visit as the presence of semen, lubricants or spermicides can make the diagnosis of a vaginal infection more difficult. Women should also avoid douching, using a tampon or vaginal medications (ie., thrush medication) prior to the visit.

A doctor will examine the genital area to look for signs of other conditions and take a swab of vaginal discharge for laboratory testing. Taking a swab is an important step in obtaining a diagnosis. A doctor cannot accurately diagnose a vaginal infection by asking the woman about symptoms and/or by just conducting an examination.

BV is treated with either oral antibiotics or antibacterial vaginal creams. Recurrence of BV can be as high as 30-40% (3). Recurrent infections are also treated with antibiotics or antibacterial creams.

Prevention
To reduce the risk of recurrence, women should avoid practices that upset the natural bacterial balance in the vagina. It is best to avoid douching, using perfumed talcs and deodorants in the genital area and using bubble-bath, soap, bath salts and shampoo when taking a bath (sitting in water which contains these products can disturb the natural environment in the vagina). Having a male partner wear a condom may also be helpful as it is thought that semen may contribute to an imbalance in the bacteria in the vagina. Quitting smoking may also reduce recurrences.

Candidiasis (Thrush)

Candidiasis is caused by the overgrowth of yeast-like fungi called Candida. Candida inhabits the vagina, mouth and digestive tract in small numbers and is normally harmless. When the balance of naturally occurring organisms in the vagina is disrupted an overgrowth of Candida can occur. Thrush can develop as a result of the use of antibiotics, oral contraceptives or steroids. It is also more prevalent in those with diabetes, multiple sclerosis, a weakened immune system, a history of allergies or who are pregnant. Thrush does not appear to be sexually transmitted but is associated with some sexual practices (women receiving oral sex) (4).

Symptoms
Approximately 10-20% of women with thrush are asymptomatic (5). Symptoms are often worse in the week before menstruation. Symptoms can include:

• A thick white or creamy vaginal discharge (may be cottage-cheese like in appearance)
• Itchiness and redness in and around the vagina
• Discomfort and/or pain during sexual intercourse
• Burning on urination

Diagnosis and treatment
Women who suspect they may have a vaginal infection should visit their doctor (see Bacterial vaginosis section). Treatment for thrush involves the use of anti-fungal creams, vaginal pessaries and/or oral medication. Many of these treatments are now available over the counter (no prescription required). Women who choose to self-treat with over the counter thrush preparations should see their doctor if symptoms persist or recur as they may have a different condition (eg., bacterial vaginosis, dermatitis, lichen sclerosis, genital herpes) or a resistant strain of thrush. Recurrent thrush infections (those that have been confirmed by a doctor) may require a longer course of treatment before they go away.

Prevention
There are a number of practices that are said to reduce a woman’s chances of getting thrush. While in some cases there is limited scientific evidence about their effectiveness, many women believe they are helpful. Practices include:

• Avoid wearing tight fitting clothing like jeans and pantyhose, underwear made from synthetic fibres and panty liners (as these creates a moist, warm environment which may encourage the growth of Candida)
• Avoid douching and taking baths with bubble-bath, soap, bath salts (can upset the natural balance in the vagina)
• Change underwear daily and wash underwear in hot water (to destroy fungi)
• Maintain a strong immune system by eating a well-balanced diet, getting enough sleep, not smoking and managing stress levels
• If prescribed antibiotics for a health complaint, ask the doctor about also taking anti-fungal preparations in combination as a preventative measure
• Consuming yoghurt or other products (eg., capsules) containing the ‘good’ bacteria, lactobacilli.

There is currently insufficient evidence to support dietary changes (eliminating high sugar foods and/or foods containing yeast) in the prevention of thrush. Using plain yoghurt in the vagina also appears to be of little benefit in treating or preventing thrush (6).

Trichomoniasis

Trichomoniasis is caused by a small parasite, Trichomonas vaginalis, and is almost always sexually transmitted. Rarely, it is transmitted by the use of wet towels/washcloths (7). Trichomoniasis is associated with preterm delivery and also increases the risk of acquiring the human immunodeficiency virus (HIV) (8).

Symptoms

Nearly half of the women with trichomoniasis are asymptomatic (9). When present, symptoms may include:

• Yellow, green or grey coloured vaginal discharge
• Vaginal discharge which is frothy or has an unpleasant odour
• Irritation or itching around the outside of the vagina
• Burning sensation when urinating
• Lower abdominal pain
• Discomfort and/or pain during sexual intercourse

Diagnosis and treatment
Women who suspect they may have a vaginal infection should visit their doctor (see bacterial vaginosis section). Women who are found to have trichomoniasis should also consider being tested for other sexually transmitted infections. Trichomoniasis is treated with either oral antibiotics or vaginal creams. It is important that current sexual partners are treated at the same time to prevent a woman becoming re-infected. Alcohol should be avoided during treatment as combining it with some of the antibiotics used can cause severe nausea and vomiting.

Prevention

The best strategy to avoid being infected with trichomoniasis is to always practise safe sex. Barrier protection (condoms, dams) should always be used when having sex with a partner whose previous sexual habits or partners are unknown.

References

1. Stewart E & Spencer P. The V Book: Vital Facts About the Vulva , Vestibule, Vagina and More London: Piatkus, 2002 p222
   
2. Stewart E & Spencer P. Ibid
   
   
3. Schwebke, JR. Vaginal infections. In Goldman, MB & Hatch MC. Women and Health San Diego: Academic Press 2000 p356
   
4. Watson C & Calabretto H. Comprehensive review of conventional and non-conventional methods of management of recurrent vulvovaginal candiasis Aust NZ J Obstet Gynaecol 2007 Vol 47 No 4 p262-272
5. Dayan L & Wines N. Management of common vaginal discharges Medicine Today 2001 Vol 2 No 4 p79-86
6. Watson C & Calabretto H. Ibid
7. Syrop, J. Vaginal infections: What you should know The Female Patient Supplement 23 p25-27
8. Dayan L & Wines N. Ibid
9. Schwebke, JR. Ibid p354

Further help and information from Women's Health Queensland Wide

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Further reading

See our

• Chlamydia factsheet
• Gynaecological health library booklist
  

This factsheet was originally published in October 2001. It was revised by Kirsten Braun and the Editorial Committee in March 2005 and July 2009.

Last Modified: July 29, 2009