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Candidiasis – Genital Thrush – Yeast Infection

Candidiasis – Genital Thrush – Yeast Infection

The following © information is an extract from
“Sexplained One – Sex & Your Health” by Helen J Knox used here with permission.

"Sexplained One - Sex & Your Health"

“Sexplained One – Sex & Your Health”

Available in print from KnoxPublishing.com or as an e-book via iBooks and Kobo

 

What is genital thrush?

Genital thrush, or candidiasis, is one of several fungal or yeast infections and it is not categorised as a sexually acquired infection.

Although there are approximately 150 different types of candidiasis, genital thrush is usually caused by the organism called Candida Albicans, and occasionally another called Candida Glabrata.

Here, the term genital thrush rather than Candida, candidiasis or yeast infection will be used. But around the world, it is also called by other names.

 

What are some other names for genital thrush?

Genital thrush is commonly called: 

* candidiasis; 

* yeast infection; 

* fungal infection; 

* genital thrush infection. 

In women, it is also called vulvovaginal candidiasis (VVC).

 

Previous names include: 

* Monilia Albicans; 

* Oiladum Albicans;  

* Mycotorula; and/or 

* Torulopsis.

 

Is genital thrush sexually acquired?

No. Genital thrush is not sexually acquired. Anyone can develop it, even if they have never had sex.

If the vagina is dry, it may be aggravated by penetrative sex and by the internal ejaculation of, particularly alkaline semen. 

Oral sex may increase a woman’s chance of developing genital thrush, but masturbation is quite safe.

 

Where does genital thrush come from and occur?

Genital thrush is caused by the yeast, called Candida, which commonly lives asymptomatically — that is without showing any symptoms — and without causing any harm, in healthy, balanced bodies.

When normal conditions change, it multiplies. 

It particularly likes warm moist areas of the body, such as the vulva and vagina in women and under the foreskin of uncircumcised men. 

It can live in skin folds, such as sweaty armpits, under large breasts, in the groin, between fingers and toes, under nail beds and in the mouth and gut.

It also lives in the nappy area and the mouth of babies, older people and those whose immune system is not working properly. 

Genital thrush commonly affects women rather than men, particularly at times of hormonal fluctuation. 

However, men whose genital skin reacts to genital thrush commonly present with balanitis. Women generally exhibit increased vaginal discharge and irritation. (see Balanitis)

 

How common is genital thrush?

The majority of women will experience genital thrush at some time in their lives and many harbour it without any symptoms that require treatment. 

Genital thrush is the second most common cause of abnormal vaginal discharge in women of childbearing age; the first being BV (Bacterial Vaginosis) – and many women with thrush think they have BV and vice versa – although, the two can be found concurrently.

 

When does genital thrush most commonly occur? 

Genital thrush commonly, but not exclusively, occurs:

* around the time of a woman’s menstrual period; 

* during pregnancy; 

* when some antibiotics are taken, since they may upset the normal levels of gut and vaginal bacteria;  

* if vaginal sex occurs after anal, without washing the penis or changing the condom; 

* when bubble bath or scented soap is used; 

* and when synthetic underwear is worn instead of cotton.

 

Can genital thrush be treated?

Yes. Genital thrush can be treated and may not be troublesome again.

However, Candida is commonly found in healthy people and given the right conditions; it may reappear problematically in anyone. 

If there are four or more outbreaks of genital thrush in a year, further investigation about the underlying cause and a variety of treatments may be recommended.

 

How is genital thrush passed on?

Genital thrush is not considered to be a sexually transmittable infection; merely a condition brought on by an imbalance of the normal environment. 

 

Can a man get genital thrush?

Yes. Men who are not circumcised may develop genital thrush under their foreskin, particularly if they do not wash the area regularly and keep it dry.

Circumcised men are not commonly affected by genital thrush. (See Balanitis)

Men whose partners have genital thrush do not need to be treated unless they have symptoms as well.

 

Do any other infections present in a similar way as genital thrush? 

Genital thrush sometimes presents in a similar way as BV, and they are often found together.

Many women think they have genital thrush, simply because they itch when they actually have vulvitis (inflammation of the vulva, the external female genital area) for a range of reasons. 

(See BV and Non-Sexually Acquired Common Skin Changes.)

 

What are some other triggers and causes of genital thrush?

Genital thrush is more common 

when you:

* are pregnant; 

* wear tight jeans or nylon underwear; 

* wear thongs or g-string underwear;

* are taking certain antibiotics; 

* have diabetes; 

* are run-down, stressed or unwell; 

* have unprotected sex with someone who has genital thrush. 

 

Don’t Douche!  

Although not a specific risk factor for genital thrush, washing internally can upset the normal bacterial balance, which encourages BV (bacterial vaginosis) to develop — and genital thrush.

 

Tight trousers or nylon underwear 

Synthetic clothing encourages sweating and enables a warm moist area for the yeast to flourish.

Therefore, wear cotton underwear instead of synthetic. To kill any remaining spores (yeast particles) after washing underwear, and to reduce the chance of re-infection, ‘hot iron’ the gusset and seams of any underwear worn during an outbreak of genital thrush.

 

Tampon use 

  • Tampons and sanitary pads are not thought to cause genital thrush. However, it may be helpful to wear pads rather than use tampons during a menstrual period, particularly if you are someone who leaves tampons in place longer than the manufacturer recommends, or if you use a more absorbent one than you need. 

  • Tampons are designed to absorb fluid. Occasionally, extended use can contribute to vaginal dryness, subsequent irritation and occasionally malodour (unpleasant smell), suggestive of BV – both of which may trigger genital thrush.

  • Some sanitary pads are more comfortable than others. Some seem to encourage sweating more than others, which can trigger genital thrush. 

  • Choose your pads carefully, particularly if you get recurrent attacks or vulval discomfort during or close to your menstrual period.

  • Chemicals used in the bath can trigger an outbreak.

  • As much as you may want to smell nice and feel fresh and clean, avoid using products, which can irritate and dry the skin, or even trigger allergy or BV (see BV). 

  • These include products like vaginal perfumes and deodorants, bubble bath, scented soap and, in particular, disinfectants such as Dettol or TCP in your bath. 

  • Sometimes allergic reactions look like genital thrush to the naked eye, so it is sensible to take a swab from the affected site for laboratory confirmation and diagnosis. (see ‘Tests’ below)

 

Vaginal dryness

To avoid friction soreness and subsequent irritation, if you are dry before or during sex, use water-based lubricant instead of saliva, which may contain Candida. 

If you use latex condoms, avoid scented oils or non ‘latex-friendly’ products, which may encourage an imbalance of vaginal conditions, cause further irritation and make a latex condom break.

 

Personal hygiene 

Always wipe from front to back after opening your bowels. 

If you wipe the other way, you can introduce bowel germs to your vaginal and urethral entrance, giving unfriendly bacteria the opportunity of triggering cystitis (see cystitis).

 

Who else can genital thrush affect?

Other conditions with which people are more prone to genital thrush include:

* uncontrolled diabetes 

* psoriasis or eczema (skin conditions);  

* asthma (a lung condition); 

* underactive thyroid gland (hypothyroidism); 

* impaired immunity (immunosuppression) – for example, people who have HIV disease (AIDS), are living under severe stress and are, therefore, ‘run down’. The same is true for people with cancer who are being treated with chemotherapy or people on anti-rejection medication following an organ transplant.

 

Can yeast or fungal infection affect other parts of the body?

Yes. Yeast infection can affect other parts of the body. 

Since the different types of yeast or fungal infection can affect all areas of skin, babies, immunosuppressed and elderly people are most commonly affected.

 

Some examples include:

* fungaemia – candidiasis or yeast infection can involve the oesophagus (the passage food takes from the mouth to the stomach) and become ‘systemic’. In other words, the yeast or fungus can affect the entire system via the bloodstream. Thankfully, this medical condition is very rare, but it can occur and can be life-threatening;

* intertrigo – also called Cutaneous Candidiasis, is a yeast infection of the skin that is caused by Candida. It develops in warm moist or sweaty areas of the body, such as in the armpits, under large breasts, in the groin of overweight people, or in the folds of skin under babies’ nappies;

* seborrhoeic dermatitis – which simply means inflammation of the skin. One form, commonly called ‘dandruff’, occurs on the scalp. Dry, scaly patches may occur on other areas of the body after inflammation of the skin. When it occurs as eczema, it is called seborrhoeic eczema.

 

Tinea 

Yeast or fungal skin infections are commonly named after the affected parts of the body, in Latin. 

Some examples include: 

* Tinea pedis — Athlete’s foot, which is a fungal infection in the moist skin fold between the toes;

* Tinea cruris — commonly called ‘jock itch’, is an infection in the groin, where the leg joins the pelvis;

* Tinea capitis — which presents as red, itchy areas on the head and can destroy hair growth in the affected area;

* Tinea corporis — commonly called ‘ringworm’, presents as a fungal infection of the skin on the arms, legs, chest or face — and, perhaps surprisingly, has nothing to do with having worms;

* tinea unguium — also called onychomycosis, (pronounced ony-ko-my-ko-sis) is when the fungal infection causes thickened and perhaps crumbly nails.

 

Does the oral contraceptive pill give a woman genital thrush?

No. Today’s oral contraceptive pills contain a low dose of oestrogen compared with the higher dose pills of the past.

So, although the vagina is exposed to the female hormone oestrogen, which can encourage the growth of candida, nowadays, healthy women, who use the combined oral contraceptive pill are no longer thought to be at an increased risk of developing genital thrush.  (Ref: FRSH.org 2012)

 

Can I catch genital thrush from a toilet seat?

No. You cannot ‘catch’ genital thrush from a toilet seat. It is a condition that develops not an infection that can be transmitted.

 

What about sharing sex toys, towels or other intimate objects?

Although not considered to be a sexually acquired infection, just as you would not share sex toys, towels or other intimate objects with someone you knew to have a sexual infection, it is more hygienic not to share them with someone who has genital thrush, either.  

See the section on Safer Sex.

 

What might a man notice if he has genital thrush?

Men with genital thrush may notice one or more of the following:

* a thick, smelly discharge under their foreskin, which may smell a bit ‘cheesy’ and can itch; 

* balanitis or balanoposthitis — inflammation or irritation of the glans penis and prepuce, commonly known as the head of the penis and foreskin; 

* penile erythema — or reddening of the skin — commonly under their foreskin or on the tip of their penis;  

* penile fissures — or tiny tears or splits to the skin of their penis;  

* penile oedema — or unusual swelling, caused by fluid retention;  

* if they are uncircumcised, men may develop phimosis — a swollen, tightened foreskin which, if left untreated and there is sufficient difficulty retracting it (pulling it back) over the head of the penis, may require circumcision (surgical removal) to resolve the problem. 

 

What might a women notice if she has genital thrush?

Women with genital thrush may notice one or more of the following: 

* commonly there is a thick, white vaginal discharge — with a curd-like consistency that is similar to cottage cheese;  

* malodour — although thrush does not usually smell, there may sometimes be a yeast-like odour (a similar smell to that of mixing dough to make bread); 

* vulval and/or vaginal irritation and/or itching, which may be quite intense;  

* superficial pain during sex and/or generalised erythema in the vulva (redness and soreness in the genital area);  

* vulval rawness and redness from scratching, which may lead to an excruciatingly painful, burning sensation when passing urine;  

* generalised oedema (swelling, due to fluid retention), fissure formation (small skin tears) and lesions (sores) away from the initial area which may appear like a very sore ‘nappy rash’, perhaps even spreading to the anal area and buttocks.

 

Where is genital thrush found in the body?

As the name implies, genital thrush is found in the genital area. 

Oral Thrush can also occur. It is found, as its name implies, in the mouth.

 

What complications may occur if genital thrush is not treated?

Genital thrush is not a life-threatening condition and depending on how severe an outbreak is, may disappear without treatment. 

However, since it can appear at times of illness and vulnerability to other infection, recurrent cases should be investigated carefully, understood well and perhaps treated differently. 

Excruciating discomfort can occur with genital thrush, especially in a woman if she develops cystitis (inflammation of the bladder) at the same time.

This combination can make passing urine an agonising but, though thankfully not life-threatening experience.

NOTE: if this happens to you, passing urine in a warm bath of water may be more comfortable, minimising the discomfort felt when urine passes over inflamed or broken skin. Make sure you wash the bath out carefully afterwards, before anyone else uses it!

 

Can genital thrush cause infertility?

No. Genital thrush is not associated with infertility.

 

Does genital thrush affect the baby if a woman has it when she’s pregnant?

  • No. Genital thrush does not affect the baby during pregnancy. Small babies often develop thrush in their mouth,  which is easily treated.
  • The presence of asymptomatic genital thrush (without bothersome symptoms) is quite common in pregnancy.
  • The hormonal fluctuations of pregnancy often encourage symptomatic genital thrush to occur.
  • Some treatments are not recommended for pregnant women.
  • If self-medicating during pregnancy, or buying treatment without a prescription, it’s important that women only use a treatment that’s recommended by a qualified healthcare professional. 
  • If I’ve had genital thrush, will I still be able to have a baby?
  • Yes. Having genital thrush does not stop women becoming pregnant or having a baby. It does not affect fertility. Indeed, many women experience genital thrush during pregnancy.

 

What tests are there to check if I’ve got genital thrush?

Tests for genital thrush depend on the setting in which examinations are undertaken. They include:

* swab analysis — when a sample of the discharge is taken with a long handled, sterile cotton wool bud that is gently rolled through the discharge, or over a sore or itchy area. The laboratory then cultures (grows) the specimen in an incubator for a few days before confirming diagnosis and recommending appropriate treatment;

* glass microscopy — a similar sample is taken with a swab and then rolled over a glass microscope slide. That’s then treated with special chemicals. Skin cells that have been sampled are destroyed, but the Candida remains untouched. The spores (small powdery cells) and hyphae (branches) of the yeast infection become visible under the microscope. When lots of them are present, it suggests that yeast infection is present;

* physical examination — undertaken by an experienced healthcare professional, who can see and sample the discharge as well as listen to your description of signs and symptoms. They may give you their clinical diagnosis and perhaps, suggest initial treatment to alleviate symptoms while waiting for laboratory confirmation. Depending on their qualifications, they may also offer additional examination to check for pelvic tenderness, suggestive of further infection.

* urine tests — these may be performed to rule out diabetes as an underlying cause, particularly in recurrent cases;

* and sometimes, blood tests may be suggested to rule out conditions such as diabetes, anaemia or HIV infection, which can each suppress the immune system and predispose people to genital thrush — or in rare cases, check for fungaemia, the presence of fungus in the blood. 

 

Where can I be tested for genital thrush?

  • If you are worried about having genital thrush, think you may have a SAI or want just more information about them, you can talk to:
  • * your local sexual health or genito-urinary medicine (GUM) clinics;  
  • * staff at your local family planning clinic. Depending on which country you are in, they may be able to help; 
  • * your family doctor or the practice nurse, who may be equipped to help you and take samples; 
  • * your nearest hospital, which can give you advice, local information and the opening times of appropriate clinics.

 

How soon after unprotected sex can I be tested for genital thrush?

Tests for genital thrush can be performed anytime, especially when there are symptoms from which to take samples.

 

How accurate are the tests for genital thrush?

On physical examination, classic genital thrush is easy to see.  Laboratory tests are extremely accurate and reliable. The benefit of double-checking with a laboratory test is to ensure that the presence of another treatable infection is not being masked by genital thrush symptoms.

 

Can the test show how long I’ve had genital thrush?

  • No. Tests don’t show how long genital thrush has been present. When you have it enough to require treatment, you are generally aware.
  • If I have genital thrush, should I have tests for other sexual infections?
  • Yes. If you have genital thrush and are sexually active, you should have tests for other sexual infections.
  • Sexual infections tend to ‘hunt in packs’, co-exist or travel together, making the presence of another infection possible when genital thrush is present and it can mask (or hide) gonorrhoea, chlamydia, herpes or warts.

 

Is there a link between genital thrush and HIV infection?

Yes. There appears to be a link between HIV and recurrent genital thrush, and particularly oral thrush that won’t go away. It can indicate that someone’s HIV infection has progressed towards HIV disease or  AIDS. When genital thrush is present, an inflammatory reaction occurs, causing vulnerability to further infection.

 

If I have genital thrush, should I have an HIV test?

  • Yes. You should have an HIV test if you have genital thrush. 
  • It’s important that everyone knows his or her current HIV status. If you have not been screened in the last year or since you changed sexual partner(s), it is a wise thing to do. 
  • People who have recurrent genital thrush would be particularly wise to rule out HIV infection as an underlying reason for its recurrence. 

 

Do I need to be tested after treatment, to make sure I’ve been cured?

No. You don’t need a test of cure after treatment for genital thrush.

However, depending on your trigger factors, genital thrush commonly recurs and can take some time to understand.

 

How much does a genital thrush test cost?

Depending on where in the world you are and in the interest of public health, tests for genital thrush and STIs are usually free or at a minimal charge.

If you are seen privately, charges vary according to tests taken and the laboratory used for analysis.

 

What treatment is there if I’ve got genital thrush?

Treatment consists of:

* steroidal and non-steroidal anti-fungal creams (such as clotrimazole / Canesten®), pessaries (solid pellets of medication that are inserted into the vagina), orally administered capsules and homoeopathic or self-help remedies are the most common treatments; 

* creams are commonly given to men who have genital thrush/balanitis.

Although not scientifically proven and not recommended as first-line treatment by healthcare professionals, some women find that:

* putting live natural yoghurt onto a tampon and inserting that into the vagina or putting the yoghurt around their vulva (external genital area), can be soothing, reduce scratching and in turn help the body rebalance itself (pregnant women should not use a tampon but merely apply it externally);

* adding a tablespoon of vinegar or a single drop of tea tree oil to their bath water can be beneficial;

* inserting a fresh clove of garlic into the vagina twice a day for a few days may help. Obviously, it has to be removed before another is inserted. 

 

Two Additional Notes

(1) If you are pregnant and if they don’t already know, mention this to your doctor or pharmacist, as some treatments are not recommended for pregnant women.

(2) If you use latex condoms, remember that latex and oil-based products don’t mix. Some vaginal medication contains oil, which could damage a latex condom. It is safer to avoid sex entirely while using vaginal medication, which also allows time for healthy bacteria to rebalance and comfort to return in the vagina.

 

Can genital thrush go away without treatment?

Yes. Genital thrush can disappear without treatment. It doesn’t HAVE to be treated because, with time, genital thrush generally disappears on its own. 

However waiting for this to happen will prolong discomfort, which can sometimes be quite severe.

 

After treatment for genital thrush, how soon will I feel normal again?

It depends on how severe the outbreak of genital thrush is. After treatment, it commonly takes a week or two to feel completely ‘normal’ again.

 

What should I do after I finish my treatment for genital thrush?

After treatment for genital thrush:

* avoid sex for seven to 14 days, to allow normal conditions and comfort to return to your vagina;

* work out your trigger factors, so you can avoid them and, hopefully, further outbreaks of genital thrush in the future.

 

Will my partner(s) need to be treated for genital thrush, too?

  • If your partner does not have any symptoms of genital thrush, they do not need to be treated.
  • If, however, they have symptoms, they should be tested and treated according to how they present. 
  • The most common presentation for men is balanitis or inflammation of the head of the penis. (see Balanitis)

 

Can I have sex while I’m using treatment for genital thrush?

No. You should avoid sex while you are using treatment for genital thrush. Although it may feel as if having sex can help to ‘scratch’ the itch, this can increase the soreness and discomfort afterwards, and prolong the healing process.

NOTE: Remember — condoms and oils don’t mix, and some treatments for genital thrush contain oil.

 

How can I avoid developing genital thrush?

Check the genital thrush triggers and causes, already mentioned, and avoid them or, as much as possible, avoid whatever you notice as your own trigger factor.

The following may help some people:

* avoid washing yourself too frequently or using disinfectants and bubble bath in the water;

* stop using soap – just clean yourself with water, soap substitute or aqueous cream;

* use sanitary towels/pads rather than tampons during a menstrual period;

* avoid tight fitting clothing and underwear made from nylon, use cotton instead;

* avoid wearing thongs or g-strings;

* wear stockings instead of tights;

* women should wash and wipe the genital area from “front to back”;

* inform your doctor or pharmacist if you think you may have developed genital thrush after taking antibiotics, so they can give you additional treatment.

 

Is there a vaccination against genital thrush?

No. There is no vaccination against genital thrush. It is not caused by a viral infection but by yeast.

 

Can I become immune to genital thrush or can I catch it again?

No. You cannot become immune to genital thrush. Once you have been treated, you can develop it again.

 

If I get genital thrush again, will it show in a similar way?

Yes. Genital thrush usually presents in a similar way each time.

 

How soon can I have sex after my treatment for genital thrush?

Depending on how severe the outbreak was, to give your body time to return to normal and for sex to feel comfortable again, you should avoid sex during treatment and for approximately seven to 14 days after it ends. 

 

What about oral sex and genital thrush?

An association between recurrent genital thrush and recent female receptive oral sex (cunnilingus) has been found.

 

What about vaginal sex and genital thrush?

Vaginal sex does not cause genital thrush, but it does develop in the vagina for a range of reasons, as already mentioned.

 

What about anal sex and genital thrush?

Anal sex is not generally linked with genital thrush. In order not to contaminate the vagina, there should be no vaginal penetration after anal without either washing the penis or changing the condom.

Although anal sex is not linked directly with genital thrush, if it is practised, it should always be protected. 

There will always be a risk of contact with blood during anal sex and having unprotected anal sex, just once, with an infected partner could be enough to contract HIV or Hepatitis B/C.

 

Can a woman catch genital thrush if she has sex with other women?

A woman may pass genital thrush to another woman if there is mouth to vulva contact, in other words, unprotected oral sex.

 

Can a man catch genital thrush if he has sex with other men?

No. Genital thrush is not transmitted between men. Although genital thrush is commonly considered to be a female infection, men can develop balanitis or inflammation of the head of their penis. Rectal thrush occurs in MSM, especially those with HIV infection.

Logically, unprotected oral or penetrative sex between men could trigger balanitis, perhaps caused by genital thrush. Particularly if their immune system is not working properly or their personal hygiene is not as good as it could be.

 

Can a child get genital thrush?

Yes. Although thrush is not a sexually acquired infection, it can develop on other warm moist areas of anyone’s body, not just adults or the genital area.

 

Is there a link between genital thrush and cervical cancer?

No. Genital thrush is not linked with the development of cervical cancer. 

However, women with cervical cancer may be more prone to developing genital thrush, due to an imbalance in normal vaginal conditions. 

All women, who have ever been sexually active (even if they are not now), should have regular cervical smear tests (pap / Papanicalou tests).

 

When I use hormonal contraception, will the treatment interfere with my protection?

See the section on Safer Sex.

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