CANDIDOSIS, OR MILKWAY, is considered the most common cause of discomfort and itching in the vulva and vaginal discharge. 75% of women have had at least one episode of thrush in their lifetime , and almost half have it repeatedly. The situation is almost like with ARVI : it happens in the majority, it has been studied well, but there is no vaccine or other way to eradicate this condition – but full of misconceptions associated with it. We figure out where candidiasis comes from and what to do with it.
What is the reason
Candidiasis is caused by the fungus Candida, most commonly Candida albicans, although others are also found. In general, candidiasis can be not only a relatively harmless infection of the mucous membrane – on the genitals or in the mouth – but also a dangerous systemic condition, with damage to internal organs, when the fungus is detected in the blood. This is called invasive candidiasis and requires serious treatment. In this article, we only talk about vulvovaginal candidiasis.
The fungi that cause thrush are a normal part of the genital microflora; the problem arises when there are too many of them. They enter the cells of the mucous membrane, provoking inflammation, and there are characteristic white cheesy discharge, itching, burning or pain, including during sex or urination.
The microbiome of the vagina and vulva is both a stable and fragile system: it can maintain itself for a long time, but it can also be easily disrupted. Considering that one of the influencing factors is hormonal, thrush occurs in 30–35% of pregnant women and in 30% of women with endocrine diseases.
Other important risk factors are taking antibiotics, impaired immunity (thrush occurs in almost half of people with HIV infection), high humidity and temperature, including due to tight clothing, synthetic underwear, and pads. Douching and the use of spermicides can contribute to thrush – they also interfere with the composition of the microflora.
Contagious or not
Candidiasis often occurs for the first time after the onset of sexual activity. As for the transmission of infection, the same wording is found in Russian , Australian , American therapeutic recommendations: candidiasis is not sexually transmitted and is not considered an STI, which does not exclude its occurrence on the partner’s penis.
True, when studying lesbian and bisexual couples, it turned out that the number of partners over the past year was directly related to the risk of thrush. The researchers concluded that sexual transmission of Candida species between women is possible. However, by default (if there are no complaints), there is no need to treat the partner or partner.
How to treat and when to see a doctor
For acute candidiasis, there are several options : vaginal antifungals in suppositories or creams, or fluconazole in a capsule to be swallowed – topical treatment usually takes about a week, and the capsule is taken once. These methods are considered to be the same in effectiveness and safety, that is, none of them is better than the other. It is better for pregnant women to choose local drugs.
If thrush occurs for the first time, if you are not sure if it is thrush, if over-the-counter medications do not help or help for a short time, you need to see a doctor. The diagnosis is established not only on the basis of complaints, the type of discharge and inflammation of the mucous membrane – a laboratory study is also needed . To do this, take a swab from the vagina, which is sent to the laboratory and there can be studied by various methods – from microscopy to determining the DNA of Candida fungi.
Obstetrician-gynecologist Oksana Bogdashevskaya says: “Of course, you cannot force anyone to come to an appointment every time, and it happens that the symptoms are well known, and the drug from the pharmacy quickly helps. If in doubt, you need to see a doctor. It is easy to confuse thrush with another condition. I personally know two gynecologists with fifteen years of experience: one was sure that she had persistent bacterial vaginosis, the other was tormented by thrush. During the examination, it turned out that everything was exactly the opposite. Even if doctors cannot diagnose themselves on the basis of a clinical picture, then what can we say about patients. ”
If there are endocrine disorders, they need to be treated – for example, with diabetes mellitus, to achieve good control of blood sugar levels. When prescribing antibiotics by default, antifungal agents are not needed – but those who have candidiasis four times a year or more may need them. Such a thrush is called recurrent, and it is worth discussing with the gynecologist the prevention of its exacerbations – to find out what to do if you are prescribed antibiotics or, perhaps, which intimate hygiene product is best for you.
Given that hot and humid environments can promote fungal growth, it is best to choose cotton underwear, especially in hot climates or in summer. For women who have sex with women, it is recommended to avoid contact between the genitals (or between the vulva and the hands), carefully monitor the hygiene of sex toys during an exacerbation of thrush in one of the partners.