“I have been suffering from constant Thrush for years. I have tried reducing Sugar , non scented shower gels, avoiding tight clothing etc. I have been to my GP several times. I was on Diflucin treatment for six months and I when that finished , I started getting frequent thrush again. Is this normal and do you have any suggestions as to what I could do to get to clear up. I am going back to my GP this week.”
Recurrent thrush or Recurrent vulvovaginal candidiasis (RVVC) is defined as four or more episodes in one year.
Risk factors:
● Diabetes!
● Antibiotic use – Use of broad-spectrum antibiotics significantly increases the risk of developing RVVC in up to 1/3 of women .
●Increased estrogen levels – such as oral contraceptive use, pregnancy, and estrogen therapy.
●Immunosuppression – Such as those taking steroids/ immunosuppressive drugs or HIV.
What can you do? Although not based upon data from randomized trials, you can try avoiding of panty liners, pantyhose, cranberry juice, and topical lubricants to see if there is improvement. You can talk to your GP to try to reduce risk factors such as controlling diabetes or switch to lower estrogen dose oral contraceptive. What doesn’t work? Yogurt. Although there is a popular belief that ingestion or vaginal administration of yogurt or other agents containing live lactobacilli decreases the rate of candidal colonization and symptomatic relapse, it really doesn’t work. (yes, it’s been studied.)
No studies have shown any benefit from a change in diet in preventing and controlling thrush. Occasional patients report episodes after consuming beer or refined sugar , especially when consumed in excess. If you think it triggers yours, worth trying to stop it and see, but hasn’t worked for most patients in studies.
Some women with RVVC require long-term treatment regimes with fluconazole. The first line is a 6 month course.
If you get recurrence after the 6 month course (which is where you are at, and not at all uncommon), there are 2 things that your GP can suggest. One is a second, 12-month course of fluconazole. The other is whether it is time to get a culture of the thrush to see if it is a resistant form of thrush that might need a different treatment.
Top tip: do not apply vaginal yogurt before attending your doctor for thrush/etc., just in case you need an exam or to take a culture. It doesn’t treat it (urban myth) but it can make it impossible to get a culture/sample for testing. [Not from a publication; that is just from my personal experience way back in my intern year when a patient self-treated with the yogurt off of her hospital breakfast tray.]
For absolute best information and fact-checking on women’s health, check out “The Vagina Bible” by Dr. Jen Gunter or her blog at: https://drjengunter.com
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