Vulvovaginal Candidiasis is a condition also known as vaginal thrush or yeast infection. It is an infection of the vagina which is typically caused by a yeast-like fungus known as Candida albicans. 

This fungus commonly lives on our skin and vagina without causing any problems. However, on some occasions, the fungi can grow out of control and cause vaginal thrush.

Some factors which may increase the chances of getting this infection include: 

• Taking certain medications such as antibiotics or high-estrogen oral contraceptives
• Being pregnant
• Living with poorly controlled diabetes
• Having a weakened immune system

The common symptoms which most women may experience include:

• An unusual vaginal discharge. This discharge is thick and creamy white, and looks similar to cottage cheese.
• Pain and/or intense itch within the vagina, and in the areas surrounding the vaginal opening
• Pain and/or itch while having sex
• Redness and swelling within the vagina and in the areas surrounding the vaginal opening

Vaginal thrush can be treated using the following medications which are available through your       pharmacist. You can ask your pharmacist to recommend a suitable treatment.

• Antifungal pessaries may be inserted into the vagina with a clean finger or an applicator. These contain antifungal medications such as Clotrimazole, Sertaconazole or Isoconazole. Depending on the product for treatment, you may need to use the medication for a course of one to six days,      
• Oral Fluconazole, an antifungal capsule, may be taken as a single dose to treat vaginal thrush. However, it cannot be used by patients who are pregnant or breastfeeding. This medication may also interfere with some medications such as oral contraceptives or antibiotics.
• Antifungal creams may be applied in the areas surrounding the vaginal opening but not within the vagina. These contain antifungal medications such as Clotrimazole, Sertaconazole, Miconazole or Isoconazole. Some creams may contain a mild corticosteroid, Hydrocortisone, which can help to reduce the discomfort and itch. 

Although vaginal thrush can be treated without seeing a doctor, there are times when the condition may become more serious. You should see a doctor if you:

• Are younger than 16 years old or over 60 years old
• Are pregnant
• Are on long-term antibiotics or oral corticosteroids
• Have abnormal vaginal bleeding
• Have four or more episodes of vaginal thrush in the last 12 months
• Previously had a sexually transmitted disease
• Have a weakened immune system e.g. living with Human Immunodeficiency Virus (HIV), cancer or had a recent organ transplant
• Have a green or fishy smelling discharge this be a symptom of another disease
• Continue to have symptoms for more than three days after completing a self-treatment

To help manage the itch and irritation caused by vaginal thrush, you may/should:

• Avoid fragrant or harsh soaps, douches, shower gels or washing around the area too often. This changes the normal conditions of the vagina, making it easier for the fungi to over-grow. Choose washes which are suitable for use in the vaginal area.
• Use a sodium bicarbonate sitz bath for relief of irritation. Add two to four tablespoons of sodium bicarbonate powder to two inches of warm bath water. Sit in the sitz bath for 15 minutes each time , for two to three times in the first week, and followed by one to two times a week as needed.
• Avoid sexual intercourse until you have recovered fully. While vaginal thrush is not commonly transmitted during sexual intercourse, the friction during sex may cause some            injury  to the vagina wall. This may further irritate the vagina wall and promote the growth of the fungi.

Below are some suggestions to prevent vaginal thrush from happening again:

• Use mild soap and water to keep the external vagina area clean.
• Avoid tight-fitting underwear and clothes which may trap heat and moisture. Heat and moisture can promote fungal growth.
• Wipe the genital area with a soft gentle wipe as scented or coloured toilet paper may contain chemicals that cause irritation. Wipe from the front to the back to prevent faecal material from coming into contact with the vagina.
• Change your tampons, sanitary pads and pantyliners frequently as wearing soiled products may  increase the risk of infection.
• Use lubricants when having sex to prevent injury to the vagina walls.
• Probiotics may help promote a healthy vaginal environment. However, the evidence in preventing vaginal thrush is not clear.

Disclaimers

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System and SingHealth), community pharmacies (Guardian, Unity and Watsons) and Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.

The content above is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment. Always speak with your physician, pharmacist or other healthcare professional before taking any medication or supplement, or adopting any treatment for a health problem.