Vaginal Thrush

Question 1

What organism causes vaginal thrush?

Answer 1

• Candida Albicans - 90%

Question 2

If candida is a normal commensal organism in the vagina, what causes symptomatic vaginal thrush?

Answer 2

• hypersensitivity response to the commensal organism due to
  
  • genetically
  • oestrogen

Question 3

Which age group is commonly affected by VT?

Answer 3

• 20-40 years

Question 4

What are the RF for VT?

Answer 4

• Pregnancy
• Diabetes mellitus
• Treatment with broad-spectrum antibiotics
• Chemotherapy
• Vaginal foreign body
• Contraceptives may predispose to recurrent vaginal and vulval candidiasis

Question 5

What are the Sx for VT?

Answer 5

• Pruritus vulvae
• Vulval soreness
• White, ‘cheesy’ discharge
• Non-offensive
• Dyspareunia (superficial).
• Dysuria (external)

Question 6

What are the signs of of VT?

Answer 6

• Vulval erythema, possibly with fissuring.
• Vulval oedema.
• Satellite lesions.
• Excoriation

Question 7

What are the differntials for VT?

Answer 7

• Bacterial vaginosis
• Trichomonas vaginalis.
• STIs
• Helminthic infection (particularly threadworm/pinworm in young girls).
• Contact dermatitis (enquire about new hygiene products).
• Mechanical irritation - eg, long-distance cyclists, sexual abuse in girls.
• Urinary tract infection.

Question 8

What Ix would you perform for VT?

Answer 8

• Self taken swabs
• MSU if UTI suspected
• Vaginal swab from anterior fornix or lat vaginal wall for MCS if suspect complicated infection

Question 9

How would you mx VT?

Answer 9

Conservative

• use soap substitute to clean vulval area
• use emollient to moisturise vulval skin
• maintain good hygiene

Pharmacological

• intravaginal antifungal - clotrimazole 500mg pessary single dose
• oral antifungal - fluconazole 150mg orally single dose
• topical imidazole
• If pregnant - use clotrimazole 100mg pessary for 6 nights

*topical treatment may worsen burning symptoms in the first few days

Question 10

What patient group are prone to getting recurrent VT?

Answer 10

• Diabetes mellitus.
• Immunosuppression.
• Broad-spectrum antibiotic use.
• A possible link with allergy, particularly allergic rhinitis