Vaginal thrush
Vulvovaginal candidiasis is the medical term for the condition vaginal thrush. The National Institute for Health and Care Excellence (NICE) defines it as "a symptomatic inflammation of the vagina and/or vulva caused by a superficial fungal infection, usually a candida species, although other yeasts are occasionally implicated." The most commonly implicated candida species is candida albicans which accounts for between 80% and 92%1 of cases of thrush.
An estimated 50%-75%1 of women will experience vaginal thrush at some point in their lives. It is most prevalent in women between puberty and menopause peaking in the age group 30 40. There is a high incidence of infection during pregnancy but it is less common in pre-pubescent girls and post-menopausal women. Approximately 10%-20%1 of women in the at risk age group will have candida as part of their normal vaginal microflora but display no symptoms.
Symptoms
The most recognisable symptom is itching around the vulva (entrance to the vagina) and is often accompanied by one or more of the following typical symptoms:
- Odourless discharge which can be thin and watery or thick and white like cottage cheese (this symptom is not always present)
- Soreness and irritation of the vulva
- Stinging sensation whilst urinating
- Pain during sexual intercourse
Thrush is described as either uncomplicated or complicated depending on the symptoms, medical history and frequency of infection.
Uncomplicated thrush is defined as mild to moderate symptoms which occur infrequently or for the first time and are not associated with any risk factors, such as pregnancy, poorly controlled diabetes or compromised immunity. Uncomplicated is most commonly caused by candida albicans.
Complicated is defined as one of the following:
- Recurrent infection - which is classified as four or more episodes in a 12 month period where symptoms partially resolve between episodes.
- Severe infection - extensive itching, redness, inflammation, damage to the vulva due to scratching or fissures.
- Symptoms caused by yeasts other than candida albicans.
- Symptoms during pregnancy.
- Symptoms present in women with reduced or compromised immunity including those with uncontrolled diabetes, HIV or customers taking systemic corticosteroids or other medicines.
When to refer?
Customers should be referred to the pharmacist if they:
- Experience symptoms for the first time.
- Are under the age of 16 or over the age of 60.
- Are pregnant or breast feeding.
- Are trying to conceive.
- Have blood-stained discharge or abnormal menstrual bleeding.
- Have discharge which is a different colour to that which is expected or has an odour.
- Experience more than two episodes within six months.
- Previously tried an OTC treatment that did not relieve symptoms or caused a reaction.
- Do not see an improvement in symptoms after 7 days.
- Or their partner had or are suspected of having a sexually transmitted infection (STI).
- Are taking other medication.