Candida: the enemy within

The fungus candida is oftentimes responsible for the thick white-yellow discharge, itching, burning and swelling in a woman’s genital area, writes DR BRIGID MONDA.

Candida in the vagina causes a thick, white-yellow discharge that looks like curdled milk with itching, burning and swelling in the genital area that makes walking, urinating or sex very painful.

Every human being has organisms living in harmless amounts as commensals or non-paying guests in the mouth, vagina, digestive tract and skin. A fungus called Candida albicans and bacteria called Lactobacilli, which reside in the vagina are examples. The Lactobacilli create a protective acidic environment in the vagina by breaking down Glycogen into Lactic acid. Glycogen is a kind of ‘sugar’ found in abundance in the vaginal cells. The acidic environment created protects the pelvic organs against infection and also prevents the overgrowth of the un-paying guests in the vagina. When the acidity in the vagina reduces, this creates a conducive environment for these un-paying guests to multiply and grow beyond a certain level and cause symptoms of an abnormal vaginal discharge.

An overgrowth of Candida in the vagina causes a thick, white-yellow discharge that looks like curdled milk with itching, burning and swelling in the genital area that makes walking, urinating or sex very painful. The medical term for this overgrowth of Candida is Vaginal Candidiasis or in layman’s terms, Thrush, or a Yeast infection, and is a source of great misery for so many women right from their teens. Most women will have had a yeast infection at one time in their lives before they reach menopause and at least half of all women have more than one episode.

Is thrush an STD?

Not at all, although this is a common misconception and is the cause of many a quarrel between couples! Thrush is not a true "infection" since there is no fungus that enters the body from the outside and it is also not a sexually transmitted disease because it is not transmitted through sex.

Why do I often come down with thrush and yet my husband is never affected?

A man’s semen is alkaline, which when in the vagina makes the vagina less acidic and the Candida is then able to multiply causing the symptoms of thrush. Men carry the spores or ‘seeds’ of Candida but with no vagina, they have no place for the Candida to grow in. Uncircumcised men with poor hygiene may develop a form of Candidiasis called Balanitis where the Candida grows under the foreskin and they will get redness, irritation and itching at the tip of the penis.

Are there things that make thrush worse?

There are triggering factors. The hormonal changes that occur just before and after one’s period and during pregnancy, hormonal treatments like HRT, thyroid hormones, prolonged steroid treatment or some birth control pills, the over use of antibiotics, sex, frequent vaginal douching, obesity, anaemia, poorly controlled diabetes or HIV, emotional stress, very hot weather, poor diet and wearing nylon stockings and tight underwear in hot weather.

Why do I come down with thrush every time I take Antibiotics?

This is because the antibiotics are not selective in the bacteria they kill and kill both disease causing bacteria as well as the beneficial lactobacilli in the vagina. With no lactobacilli to manufacture lactic acid, the vagina becomes less acidic allowing the overgrowth of candida, hence thrush. If you tend to get yeast infections whenever you take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent to take after the course of antibiotics.

Is thrush curable?

There is no absolute cure for Thrush because treatment just clears the overgrowth of Candida and reduces the numbers to what is ‘normal’. Once the overgrowth is treated, it can still recur again whenever the vaginal environment becomes favourable for it because Candida is a natural resident of the vagina. This is what is responsible for the repeated attacks of thrush despite treatment. Even if one attempted to rid the vagina completely of Candida, the vagina would still get re-colonised again by Candida from the surface of the skin.

Do the men need treatment too?

Doctors have found no benefit in treating the sexual partners of women with yeast infections unless the woman has very recurrent infections and other causes like diabetes have been ruled out.

Can’t I just buy treatment from the Chemist?

Women who treat themselves for vaginal infections before seeing a doctor are often off the mark because what they think is thrush may in fact be symptoms of a more serious condition. The burning sensation could be a symptom of a urinary tract infection, which requires an antibiotic or a sexually transmitted disease like Trichomoniasis that mimics a yeast infection or worse. Also using anti-fungal drugs when they are not needed may lead to a resistant Candida, which is very difficult to treat .It is, therefore, very important to see a doctor to make sure that you have the right problem diagnosed.

What do you do if you keep getting these infections even after treatment?

This would mean four or more vaginal yeast infections in a one-year period. Most doctors treat this problem with two weeks of oral anti-yeast treatment followed by up to six months of a lower maintenance dose and this time your partner is also put on treatment.

To avoid recurrent infections

• Do not have intercourse while being treated.