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Recurrent Thrush
Summary:
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Recurrent thrush is 4 or more infections in a year.
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It requires help from an experienced Doctor, see Finding a Doctor.
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It is linked to acquired neuropathic vestibulodynia, nerve damage of the vulvar vestibule.
What is recurrent thrush?
Recurrent thrush is when you experience four or more thrush infections within a year (NICE).
5% of women are thought to experience the condition in a lifetime.
As per the clinical name, thrush in this case recurs or keeps coming back after treatment. There is currently not enough research for us to understand why this happens in some women but not in others.
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What causes recurrent thrush?
Due to the lack of research, the exact causes are unknown, although there are factors that increase your predisposition to developing it.
This includes:
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Antibiotic use
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Poorly controlled diabetes
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Weakened immune system (particularly HIV)
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Pregnancy
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Using products that can alter the vaginal microbiome including: soaps, bubble baths and soaks
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Thrush is sometimes linked to vaginal pH changes and menstrual cycles. As well as the use of sanitary products that sometimes remove beneficial microbes that keep the vaginal biome healthy and balanced.
What is the treatment for recurrent thrush?
Treating recurrent thrush often requires a long course of anti-fungals.
The anti-fungals used will need to be tailored to the specific strain of thrush that keeps recurring.
Candida albicans usually responds well to azole therapies such as clotrimazole and fluconazole. Please note that in some cases it's safer to use fluconazole as it is gentler to the sensitive and nerve-packed vestibule skin. However fluconazole overuse can lead to liver damage. Discuss your options with your healthcare provider.
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Non-albican species of Candida are more resistant to azole therapies and therefore you will likely require strain and sensitivity testing. This will show what type of Candida is recurring and what drugs will actually work against it. Second-line therapies include boric acid suppositories and Nystatin suppositories.
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Brexafemme is a new drug available in the US specifically tailored to recurrent thrush and can be taken orally. This will not be available for some time in Europe.
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In addition to the above medications, patients suffering from recurrent thrush will do well to manage their lifestyle to promote good bacteria, their immune system and create a vaginal environment that is not conducive to candida overgrowth.
What are the risks of recurrent thrush?
Recurrent thrush can sometimes precede the onset of nerve damage in the vulva - a condition called vulvodynia. Usually the nerve-dense, rich vestibule is the region affected and the condition can also be referred to as vestibulodynia.
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Centres of expertise in North America sometimes refer to this as acquired neuroproliferative vestibulodynia. There is currently no agreement on this diagnosis amongst consultants within the ISSVD and so others may refer to it as neuropathic vestibulodynia or nerve-related vestibulodynia.
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The vaginal canal rarely becomes sensitised as there are significantly fewer nerve endings to irritate or proliferate in this region. Hence, burning or stabbing pain is usually confined to the vulvar vestibule.
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Gynaecologists are not taught about the vulva anatomy and therefore, if you suspect nerve irritation related to a thrush infection, you would do well to visit a vulva clinic or vulva dermatologist. These can be found on our provider list.
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