Family doctor

Ingredients and brands:

• Clotrimazole - Canesten, Clocreme, Clotrimaderm, Fungizid
• Econazole - Ecostatin, Gyno-Pevaryl
• Isoconazole - Gyno-Travogen
• Miconazole - Gyno-Daktarin, Micreme, Femeron
• Nystatin - Mycostatin, Nilstat
• Tioconazole - Gyno-Trosyd

The above medicines are used in the vagina to treat thrush (candidiasis). They come in a variety of different courses from one-day to 14-day treatments. They are either in creams that are used to fill an applicator then inserted into the vagina, or tablets/pessaries/ovules that are inserted using an applicator or your finger.

Thrush is a common problem caused by an increase in the fungae Candida albicans in the vagina. It is usual to have candida on the skin and in the vagina, but when there is a change in balance the fungi multiply and cause itching and discharge (thick white mucus). Killing some of the fungi with a vaginal cream or tablets inserted into the vagina brings the balance back again.

Miconazole and isoconazole kill some of the other "bugs" that may sometimes cause the infection, not just candida. Econazole and clotrimazole are mostly just effective against candida. A doctor will usually take a swab from the vagina to check that the problem is thrush. It is important to exclude other infection which may cause a similar discharge.

Nystatin (Mycostatin or Nilstat) takes the longest to work, and should be used every day for 14 days in a row, and right through your period if you have a period during the 14 days. All other products are used for a shorter length of time, and generally advise that you do not use them during your period.

Canesten has the most variety. It comes in tablets for insertion into the vagina or cream, and has one dose packs, three-day packs and six-day packs. The short treatments (e.g. one dose only or three days) work well, but if you are taking antibiotics you are best to use a treatment that covers the length of time you take the antibiotics, plus a little bit longer - otherwise the thrush may return. The shorter treatments are usually more concentrated, so perhaps could cause more irritation.

There is a medicine called fluconazole that comes in a capsule to take by mouth, however the most common medicines to use are the creams and tablets for use in the vagina. Usually the capsule is used if the treatment in the vagina doesn't work or if the vaginal treatments cause problems.

Possible causes of thrush include:

• Antibiotic treatment for an infection (these kill the friendly bacteria in the vagina and allow the fungi to multiply)
• Hormone changes, e.g. menopause, oral contraceptive
• Diabetes
• Wearing tight clothes such as jeans or bike pants
• Pantyhose
• Warm weather

Some women have the problem often, while others only have it very rarely. In some countries you can buy thrush treatments without a prescription, however there are a number of cases in which you would be best to see your doctor.

See your doctor if:

• You are pregnant
• Your immune system is not working properly (e.g. AIDS)
• You have a regular problem with thrush (e.g. more than twice a year)
• You have tried a thrush treatment but it didn't help or only helped for a short time
• You have bleeding or sores or blisters inside the vagina or on the surrounding area
• You have a discharge that is not white/cream
• You are under 16 years old or over 60 years old
• You have pain

Use:

• Use according to your doctor or pharmacist's directions, or the directions on the pack.
• It is important to use the medicine for the full length of time recommended, or the problem may return, e.g. three nights in a row or six nights in a row.
• Insert the dose high into the vagina - usually there will be an applicator provided. It is best to use the cream or pessaries at bedtime.
• If only one applicator is provided for more than one dose, clean the applicator well after using, and throw away after the course has finished.
• You may also want to use a cream on the outside around the vagina opening, e.g. Canesten cream or Daktarin cream.

Cautions:

• While most of the vaginal thrush medicines can be used during pregnancy, if you are pregnant do not buy the thrush medicine without seeing the doctor first. If pregnant you may be best not to use the applicator.
• Most of the thrush medicines can damage condoms or diaphragms and interfere with spermicidal creams or jellies, increasing the risk of pregnancy if used together. Gyno-Travogen ovules may not have this problem.
• Do not use any product you are allergic to.
• If the discharge is not white, if there is pain, or if the skin around the vagina is damaged or blistered, see your doctor.

Side effects:

• Irritation and burning can occur in the vagina
• Allergy
• There may be other side effects, so if you have any unexpected symptoms while taking this medicine, tell your doctor or pharmacist.

Interactions:

• There is a possibility of these treatments damaging condoms or diaphragms.
• There are no other known interactions.

Patient information:

• Follow the instructions on the label of the medicine or as directed by your doctor.
• Wash your hands well before using a vaginal cream or tablet.
• The treatment is best used at night before going to bed.
• Make sure you finish the course, even if you feel better, or the problem may come back.
• Sometimes it might be useful to treat your partner with a cream applied to the penis and surrounding area. Usually thrush is not a problem for men as the skin on the penis dries out and it cannot survive long. Your doctor or pharmacist will be able to suggest a cream.
• A cream can be applied to the outside area around the vagina. Usually these creams will contain the same ingredient as used in the products used into the vagina.
• Diaphragms and condoms may be damaged by these medicines.
• See a doctor if you have had more than one episode of thrush recently, if you are pregnant, or if you have a problem with your immune system.
• Some people recommend taking acidophilus.
• Avoid vaginal douching while using vaginal thrush treatments.
• Using a panty liner will protect your underwear from seepage when using the cream or pessaries.
• Avoid using soap on the area, as it is very alkaline and will make the area itchier. Use pH balanced soap substitutes such as Pinetarsol or BK Wash.
• Avoid tight clothes and pantyhose (or use pantyhose with a cotton gusset).