Austin talking about thrush on Radio 4’s Inside Health

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Transcript from Radio 4’s Inside health.

Source BBC Iplayer

One listener e-mailed to ask us to look into thrush – vaginal candidiasis – she has attacks on a regular basis despite her doctor prescribing repeated anti-fungal treatments.

Consultant obstetrician and gynaecologist Austin Ugwumadu runs a thrush clinic at St George’s Hospital in Tooting.

Ugwumadu

Thrush is an infection caused by a fungus, the most common fungus being candida albicans. It kind of colonises our body or our body’s gotten used to the presence of thrush so we can’t get rid of it or kill it but it doesn’t kill us either, so there’s some relationship between them.

Porter

So it’s living on us all of the time but we don’t get attacks of what we would regard as thrush regularly so what’s happening there?

Ugwumadu

Well what has happened is there is a certain degree of tolerance of the presence of thrush by our body, sometimes it increases in number and sometimes it decreases but it’s almost always there and we reckon at least about 30% of women carry thrush, in fact if you examine the back passage it goes up to about 40-50%.

Porter

Why do some women get attacks of discomfort?

Ugwumadu

We reckon that most women will get at least one attack in their lifetime and it usually will present as itching and discomfort in the vagina associated with a very cheesy type discharge. In severe cases there may be a rash which spreads into the inner thighs but that’s very unusual. But most women will be aware of itching discomfort, burning, irritation as well as the discharge.

Porter

What’s triggering the attack?

Ugwumadu

Ah I think that’s where the sort of action is. There are a number of things that can trigger it. Usually for any reason the thrush organisms increase in their number and one of the things that can lead to that is the use of antibiotics, so a lot of women will relate to having thrush attacks after they’ve just been exposed to antibiotics, particularly broad spectrum antibiotics.

Porter

And the link there is what – what’s actually happening?

Ugwumadu

And what is happening is as you kill the other organisms that compete with thrush organisms for food and resources then the thrush tend to just explode in numbers and that then triggers the symptoms that women get. One of the common things we find is thrush usually will exist in two forms – one form of which is a yeast, or the inactive form and the other form which invades the skin and that’s the form that produces the symptoms. So whatever triggers the attack of thrush should be able to change the thrush from the yeast form into the hyphae or the invasive form. Therefore when you do tests, for example, and you find the yeast form it may not actually be responsible for the symptoms but this is how most women get labelled as having thrush when in actual fact the thrush is just a bystander as it would have been in 50% of women.

Porter

So we’re doing a swab and we’re finding thrush there but that might just be an innocent bystander?

Ugwumadu

It’s a red herring most of the time.

Porter

So it’s important to get the diagnosis right?

Ugwumadu

Exactly. A lot of women who think that they’ve got thrush didn’t have thrush in the first place but obviously once they nip across to the local pharmacy get anti-thrush medication, particularly the cream, it makes the symptoms go away for a few days and then it comes right back and then they think oh my thrush is back.

Porter

So how should we be making the diagnosis, I mean most of these women are being seen by GPs not by specialists like you, is there anything I can do when I see them at the start to make sure the diagnosis is correct?

Ugwumadu

I think a thorough history is probably the most important, so for some women who are sufficiently vigilant to sort of relate the attacks of what they call thrush to certain exposures that probably will give the doctor some idea that this may not actually be thrush. So, for example, the use of perfumed soaps, the use of bath products and some of the products that women use for their hygienic practices, a whole load of women that do have sensitivities to those agents but they don’t know it.

Porter

So just to be clear, a local reaction to perhaps a soap, it’s not actually causing thrush it’s mimicking thrush?

Ugwumadu

Yes there are two things there. First of all it mimics thrush, there is no – an individual woman will not be able to make the distinction that these symptoms are due to an allergic reaction compared to these symptoms are due to thrush, that’s one thing. But even more importantly the sort of proteins that govern that reaction tend to suppress the local immunity in a way that allows thrush to flare up.

Porter

Right, so not only is it mimicking but it can actually trigger it as well. The key message for anyone listening to this is probably at step one it’s confirming that you’ve actually got thrush in the first place?

Ugwumadu

That is always the starting point because for most women whatever itches down there, irritates down there, tingles down there is thrush and half the time they will have self-treated themselves and decided that they get recurrent thrush and most times the GPs will buy into it because once they’ve done a sample it comes back showing yeast or whatever and then the yeast gets blamed for this but it’s not necessarily the case.