Treating recurring yeast infections

A vaginal yeast infection (vaginal thrush) is an extremely common cause of vaginal discharge - up to 3 in 4 women will have at least one episode during their lives. In most cases, thrush in women settles with simple treatment, either topical (applied to the vagina in the form of pessaries or antifungal creams) or oral (a tablet or tablets). However, some women either suffer repeated new infections, or find that they still have symptoms because the initial thrush treatment has not been effective.

What causes recurring yeast infections?

Speculum examination showing vaginal thrush

By Mikael Häggström, CC0, via Wikimedia Commons

Of women who develop a first bout of vaginal thrush, about 5 in 100 of them will get problems with recurrent vaginal thrush. In most cases, the reason why this occurs is not known. Some women just seem more prone than usual to develop thrush. However women with high blood sugar (due to poorly controlled diabetes) and women with weakened immune systems may be more likely to develop recurrent thrush.

There is some debate as to whether women taking hormone replacement therapy (HRT) or the combined oral contraceptive (COC) pill are more likely to develop a recurring yeast infection - the evidence is not yet clear.

How do I get rid of a recurring yeast infection?

If you have repeated (recurrent) bouts of thrush then one option is simply to treat each bout as and when it occurs. See the separate leaflet Vaginal Thrush (Yeast Infection) for treatments for thrush.

If you have four or more episodes of vaginal thrush a year, and your symptoms settle either completely or partially in between bouts, your doctor may suggest other options.

Before they do this, they may want to exclude another cause for your symptoms. This could include:

• Taking a vaginal swab and sending it the laboratory to check for evidence of thrush or other infection.

• Checking the pH (acidity level) in your vagina using a simple test strip. A lower pH (4.5 or below) makes it more likely that thrush is the cause. A higher pH (above 4.5) makes bacterial vaginosis (BV) or trichomonas infection more likely.

• Other swabs or tests as appropriate.

To treat thrush, your doctor may suggest:

• Using one of the treatments described above (topical treatments or tablets) - but for longer than usual. Your doctor will advise exactly how long to use the treatment for. For example, this may be for 10-14 days for topical treatments, or three doses of fluconazole 150 mg tablets, taken three days apart; and

• Giving you a prescription for treatment to take if you need it (such as fluconazole 150 mg tablets to take once a week, or weekly clotrimazole 500 mg pessaries; or

• Regular 'maintenance' treatment to stop the thrush coming back, with weekly tablets of fluconazole 150 mg, daily itraconazole 50-100 mg tablets or weekly clotrimazole 500 mg vaginal pessaries.

How to treat a recurring yeast infection will depend on your preferences and other factors such as your age (tablets may be easier than pessaries if you're aged over 60 years) and whether you're pregnant (in which case pessaries will usually be advised). If you're 12-15 years old, or it's not clear whether your symptoms are due to recurrent vaginal thrush, your doctor may recommend a hospital specialist referral.

Most women remain clear of thrush during maintenance treatment. If you and your doctor decide maintenance treatment is best for you, this will usually last for six months.

After treatment is stopped, many women remain free of thrush, or only develop the occasional bout again. However, some women return to developing recurring yeast infections. If this happens, the treatment plan can be repeated, and maintenance treatment continued for longer.

Regardless of the treatment you and your doctor agree, it's important to use lifestyle measures to reduce your risk of recurring yeast infections (you can find out more below). In addition, you should speak to your doctor if:

• Your symptoms don't get better with treatment.

• You develop thrush whilst on maintenance treatment. This may indicate that you have a resistant strain of Candida spp. which may require an alternative treatment.

• You become pregnant or are breastfeeding.

• You develop side-effects from the medication.

• You develop new symptoms, such as smelly discharge, ulcers or blisters, abnormal vaginal bleeding or a bloodstained discharge.

• You feel unwell in yourself.

Can I prevent recurring yeast infections?

The yeast that causes yeast infections, called Candida spp., thrives in warm, moist, airless environments. General lifestyle changes that help prevent single episodes of vaginal thrush can also help reduce the risk of recurrent thrush.

If you have diabetes, your risk of recurring yeast infections is higher if your blood sugar is consistently high. Working with your diabetes team to bring your blood sugar under control can cut the risk of recurrent bouts of thrush.

If you experience recurring yeast infections, your doctor or nurse may also discuss your current method of contraception with you and suggest a change. There has been talk in the past about the combined oral contraceptive (COC) pill (the pill that contains both oestrogen and progesterone hormones) possibly making recurrent vaginal thrush more likely. However, the evidence around this is a little unclear.