Ask Dr Gary: Assess causes to tackle itch

Dr Gary answers your medical questions. Photo / Thinkstock

I've had problems with multiple thrush infections this year. Clotrimazole pessaries work, but only for a month or two. What else can you recommend?

Vaginal thrush infections are extremely common. Three out of four women will have an episode in their lifetime. About one in 20 women will be unlucky enough to have recurrent episodes.

Candida yeast, the fungus that causes thrush, athlete's foot, jock itch and nappy rash, is a normal passenger on our skin. If we give it a moist, warm and airless place to grow, it will. So the first step to preventing recurrences is to go commando. Ditch the underwear (especially if it's made of synthetic fabrics) or sleep naked. We want airflow. Dry thoroughly after showering and avoid douching.

Yeast also grow best if there's no competition, so avoid unnecessary antibiotics that kill off good vaginal and intestinal bacteria. Consider taking lactobacillus supplements. These remain unproven but might help restore good vaginal bacteria. Doctors typically treat vaginal thrush with a pessary, usually clotrimazole, and treat the surrounding skin with clotrimazole cream. Recurrent cases may require much longer courses of treatment, sometimes many months.

And always keep in mind that the art of diagnosis isn't 100 per cent accurate. While a female with whitish, non-smelly, thick, creamy vaginal discharge very likely has thrush, a doctor needs to consider why she might be getting recurrences.

In rare cases, it can be due to undiagnosed diabetes (high blood sugar levels impair the immune system and encourage the growth of pathogens) or even HIV. Recurrences can also be provoked by the medications a patient is taking. Antibiotics, chemotherapy and steroids all can provoke thrush attacks. And lastly, the cause of the discharge and irritation may not be yeast at all - once in a while we find it's due to an unexpected sexually transmitted infection like chlamydia. Have a chat with your GP.