By Grace Mugadza BPharm Hons

Vulvovaginal candidiasis or vaginal thrush as it is commonly called is one of the most frequent complaints that brings women to the retail pharmacy. Sometimes they request advice from the pharmacist and other times they request a vaginal cream by name. Is the pharmacist equipped to answer all questions and give adequate advice to their clients who come to them regarding this condition?

 What causes vaginal thrush?

It is an infection caused by a species of Candida – a genus of yeast like fungi. C.albicans is responsible for over 80% of vaginal thrush infections and other Candida species are responsible for the rest.

Who suffers from vaginal thrush

It is common in women of child bearing age between the ages of 16 and 60 years.

What are the symptoms of Vaginal thrush?

  • A thick, white, curd-like vaginal discharge which does not smell offensive
  • Localized itching, burning, irritation
  • Painful or burning urine

What are the risk factors for Vaginal thrush?

  • pregnancy
  • use of high oestrogen oral contraceptives
  • use of broad spectrum antibiotics
  • use of corticosteroids
  • poorly controlled diabetes
  • obesity
  • immunological deficiency e.g. in HIV and cancer
  • frequent sexual intercourse with spermicides
  • stress

 Information the pharmacist may need to know

  • Age – Vaginal thrush a rare infection in children and post menopausal women. The patient should be referred if they are aged under 16 years or over 60 years.
  • Duration of the symptoms and other products the patient may have tried.
  • Symptoms – it may also be worthwhile to ask if the patient has recently used new toiletries like soap, shower products, bubble bath, which may be a source of allergic reaction.
  • If the partner is having any symptoms. There is no need to treat an asymptomatic partner.

Measures for prevention of Vaginal thrush

  • Avoid use of soap when washing the genital area. Soap substitutes like intimate washes may be used.
  • Wear cotton underwear and loose fitting clothing
  • Avoid sexual intercourse during an episode of vaginal thrush to avoid reinfections
  • Practice good hygiene

 When should the pharmacist refer?

  • When it’s the first time to get vaginal thrush and the patient is not confident when it comes to the symptoms and may need a vaginal swab to confirm symptoms.
  • When symptoms have not responded to an appropriate course of treatment.
  • When the patient has recurrent episodes of 4 or more infections a year
  • When the patient has a history of STI infections
  • When the patient is under 16 years or over 60years of age

 The issue of privacy

Patients seeking advice about vaginal symptoms may be embarrassed. It is therefore important for the pharmacist to try and ensure privacy. Requests for a named product may be an attempt to avoid discussion. The pharmacist, as the custodian of medicines, should ensure that the product sought is appropriate.