Candida Thrush
What is Thrush?
Vaginal thrush, also known as vulvovaginal candidiasis, is a common fungal infection caused by an overgrowth of Candida yeast in the vagina.
Small amounts of Candida normally live in the vaginal microbiome without causing problems. However, when the vaginal ecosystem becomes imbalanced, Candida can overgrow and lead to symptoms. The most common species is Candida albicans, but other species can also cause infection, including: Candida glabrata, Candida krusei, Candida parapsilosis, Candida tropicalis.
These non-albicans species are increasingly recognised in women with recurrent or treatment-resistant thrush.
Thrush is not usually classified as a sexually transmitted infection, although sexual activity can sometimes contribute to symptom flares.
Symptoms of Thrush
Common symptoms include: Intense vaginal itching, Thick white discharge (often described as cottage cheese-like), Vaginal redness or swelling, Burning or discomfort during sex, Burning when urinating. Symptoms can range from mild irritation to significant discomfort.
Some women experience recurrent episodes, where symptoms repeatedly return after treatment.
Why Thrush can keep coming back ?
Recurrent thrush is typically defined as four or more infections within a year.
Many women with recurrent symptoms report: repeated antifungal treatments, temporary improvement followed by recurrence, years of ongoing symptoms.
In many cases, the underlying issue may be vaginal microbiome imbalance (vaginal dysbiosis).
When protective Lactobacillus bacteria are reduced, Candida organisms can grow more easily.
Other factors that may contribute include: repeated antibiotic use, hormonal changes, pregnancy, diabetes, immune system changes, chronic vaginal dysbiosis.
Candida Species Matters
Standard treatments often target Candida albicans, but some women actually have non-albicans Candida species.
These species can behave differently and may not respond well to common antifungal medications.
Examples include: Candida glabrata, which can be more resistant to standard treatments; Candida krusei, which has natural resistance to certain antifungal medications. This is one reason why women may experience persistent symptoms despite treatment.
Conventional Treatment
Standard treatment usually involves antifungal medications. These may include: Oral antifungals, Fluconazole tablets, Vaginal antifungals: clotrimazole, miconazole, nystatin and other topical antifungal preparations.
For recurrent infections, treatment may involve longer courses or suppressive therapy.
However, antifungal treatment alone does not always address why the infection keeps recurring.
Integrative approach to BV
In my clinical practice, recurrent vaginal symptoms are often assessed from a microbiome perspective. This involves several steps.
1. Comprehensive Clinical History - A detailed consultation explores factors that may influence the vaginal microbiome, including: previous infections, antibiotic exposure, medications, hormonal factors, sexual health history, symptom patterns, lifestyle and diet. This helps identify possible drivers of recurrent dysbiosis.
2. Vaginal Microbiome Testing - Advanced testing can help identify:, Candida species present, bacterial imbalance, low Lactobacillus levels, mixed infections, patterns of vaginal dysbiosis. This information can guide targeted treatment rather than repeated empirical therapy.
3. Targeted Treatment - Treatment may include: appropriate antifungal therapy, treatment of mixed bacterial infections if present, strategies to disrupt microbial biofilms when relevant
4. Microbiome Restoration - Once infection is treated, restoring the vaginal ecosystem becomes important. This may include: targeted probiotic therapy, microbiome support strategies, dietary approaches that support beneficial bacteria.
The goal is to help restore Lactobacillus dominance and reduce recurrence.
When to seek my Care
If you experience: frequent thrush infections, symptoms that return soon after treatment, persistent itching or discharge, symptoms that do not respond to treatment, it may be helpful to explore underlying vaginal microbiome imbalance.
Understanding the broader microbial ecosystem can sometimes reveal why symptoms continue to recur.
For enquiries feel free to get in touch.
We provide confidential, integrative women’s health care via telehealth — accessible, private, and designed for long-term results.
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