12 December 2022

Treating thrush and other things you need to know about the vaginal microbiome

Recurrent thrush occurs in up to 5% of people assigned female at birth and can be an inconvenient and distressing condition.

New research into the vaginal microbiome has given us insight into how this may occur and ways to reduce it.

What is Thrush?

Candidiasis, more commonly known as thrush, is a yeast that is present in up to 80% of people. It is an opportunistic species, meaning it will overgrow if given the chance and this is where people can experience symptoms such as;

  • Discharge, often thick and white with a ‘cottage cheese’ appearance
  • Itchiness and / or burning of the vagina and vulva
  • Irritation or pain during intercourse

It is more common in people assigned female at birth of reproductive age, as it survives best in the presence of estrogen.

There are at least eight candida species that can cause symptoms, but the two most found are candida albicans (comprising up to 60% of all cases), candida glabrata (15-20% of cases) and candida parapsilosis (10-20%).

How does Candida Overgrow?

Being an opportunistic pathogen, candida needs a few things to overgrow and cause symptoms:

  • A surface that the candida can attach to easily, such as the vaginal wall
  • A lowered systemic immune response – this is a problem for people who are severely immunocompromised such as those with AIDS or HIV
  • Low amounts of lactobacilli species in the vaginal microbiome can reduce the pH level to make it less acidic.

Other things can increase your chances of thrush are new sexual partners, tears or irritation in the vaginal wall that make it easier for the candida to attach, diabetes, a diet high in sugar and carbohydrates, broad spectrum antibiotic use, or the oral contraceptive pill due to its effects on hormone levels.

How do I find out if I have Thrush?

Swab Testing

Your GP can perform a test using a swab to determine if this is candida or another bacterial overgrowth.

Vaginal Microbiome Testing

In cases where the thrush is recurrent or hard to get rid of, vaginal microbiome testing is indicated to check not only what species of candida you have, but also where you could be lacking in beneficial lactobacilli species.

As you can see in the image, the person who did this testing was positive for candida albicans, but also showed very low levels of beneficial lactobacilli species, which could be creating an environment where candida is thriving.

This is a very easy test that you can do yourself, at home; no need for an uncomfortable doctor visit.

What other conditions present Thrush symptoms?

  • Bacterial vaginosis
  • Trichomoniasis
  • Sexually transmitted infection (STI)

What can I do to treat Thrush?

Typical GP treatment includes:

  • Topical antifungals
  • Oral antifungals

It is important to note that some candida species do not respond to treatment with commonly used antifungals, which is why it’s important to test before you treat.

Naturopathic treatments for thrush includes:

  • Microbiome testing. This will help you to determine if the issue is about reducing candida species or increasing your lactobacilli species. The treatment is very different for both.
  • Reducing processed sugars and simple carbohydrates in your diet: yeast feeds on sugar, so the higher in carbs and sugar your diet is the more the candida is going to grow.
  • Avoiding wearing tight restrictive clothing, and switching to cotton or silk underwear
  • Avoiding using soaps in your genital area (rinsing with water is enough)
  • Discussing with sexual partner/s, as it can be an exacerbating factor if you’re passing it between yourselves during sexual activity
  • Including a good quality lactobacilli probiotic specifically formulated for the vaginal microbiome to rebuild your protective lactobacillus species
  • Upping your garlic intake for its antimicrobial action
  • Herbal medicine to support you holistically: gymnema, calendula, kolorex (horopito)
  • Dietary, lifestyle and herbal medicine support to promote hormone balance

Recurrent thrush can be a really distressing condition, and too often the treatment (antibiotics, antifungal creams or tablets) can miss the mark because it’s not addressing the vaginal microbiome in its entirety.

Naturopathy offers many solutions to support people experiencing this, from treating current infections to preventing future ones. If this is something you suffer with, please reach out to see how I can help.

Author
Margaret Scott
Naturopath BhSc

Margaret is a degree qualified naturopath with a focus on women’s hormonal health throughout the lifespan.

Learn more about Margaret here

Book a session with Margaret here

References

https://pubmed.ncbi.nlm.nih.gov/35005777/

https://pubmed.ncbi.nlm.nih.gov/31992328/

https://pubmed.ncbi.nlm.nih.gov/30565745/

https://pubmed.ncbi.nlm.nih.gov/34374560/

https://pubmed.ncbi.nlm.nih.gov/31963487/

https://pubmed.ncbi.nlm.nih.gov/33918150/

https://pubmed.ncbi.nlm.nih.gov/25305660/

https://www.ncbi.nlm.nih.gov/books/NBK543220/

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