Thrush – alternative treatments to over-the-counter pharmaceuticals

What is thrush? 

 

Vaginal thrush or yeast infection is the common name for an infection of the vagina and vulva most commonly caused by the pathogenic yeast Candida albicans. Thrush is an opportunistic infection, meaning it takes advantage of the body’s weakened defence mechanisms including a weakened immune system, alterations in the microbiota and permeability of the epithelial cell wall barrier of the vagina.

Approximately 75 per cent of women will experience vulvovaginal candidiasis during some stage of their lives. Thrush is also more common throughout pregnancy, affecting up to 40 per cent of pregnant women, in post-menopausal women, with uncontrolled diabetes and with use of oral contraceptive pill and antibiotics.

Pathogenic Candida albicans are able to destroy cells within the vagina leading to inflammation, immune responses and, as a result, the symptoms associated with this condition.

 

What are the symptoms?

 

Symptoms of vulvovaginal candidiasis are specific to the vagina or vulva regions of the body and can include:

Inflammation (redness)
Intense itching
Thick, white vaginal discharge, usually resembling cottage cheese
Pain during intercourse or urination.

The body’s own defence against candidiasis

 

Vaginal pH 

The pH of the vagina should ideally be between 3.5–4.2, which provides an acidic environment that inhibits the growth of pathogenic microorganisms including Candida albicans.

Microbiota

One of the body’s defence mechanisms against Candida albicans is the microbiota that live within the vagina. Certain strains of bacteria within the vagina produce antimicrobial substances as well as lactic acid, which promote a more acidic environment and which pathogenic microorganisms are unable to survive in. Studies have shown that women with a microbiota that is Lactobacillus-dominant have a reduced risk of reproductive tract infections.

Epithelial cell barriers 

The epithelial cells of the vagina are part of the innate immune system and contain receptors that respond to various pathogens by triggering immune responses and the release of antimicrobial and antifungal substances. These cells also trigger the release of substances that function in repairing and remodeling the epithelial cells following damage caused by pathogens such as Candida albicans.

Recurrent thrush

Recurrent thrush is the presence of four to six vulvovaginal candidiasis infections a year. Research suggests that a contributing factor to the recurrence of thrush is the result of biofilm. A biofilm is a structure that may be formed on the surface of vaginal epithelial cells, which certain microorganisms may embed in. This structure provides protection of the embedded microorganisms against external unfavourable environments or threats such as antibiotics and the body’s own immune defences. Biofilms allow microorganisms to persist for longer periods of time and re-emerge when conditions within the vagina are more favourable, providing an explanation as to why infection may re-emerge even after treatment. Certain Candida albicans have also demonstrated the ability to neutralise the acidic environment of the vagina created by lactobacilli as well as alter immune responses, which allow these microorganisms to persist against the body’s natural defence mechanisms.

Naturopathic treatment of thrush

As with all naturopathic medicine, the focus on the treatment of thrush is to aid the body’s own healing mechanisms. In the case of thrush, this treatment aims to support the body’s mechanisms to efficiently fight off infection and prevent further infection and susceptibility. But how do we do this? First, we need to remove risk factors which may be contributing to changes in the environment of the vagina and that promote the overgrowth of Candida albicans.

 

Creating changes in the microbiota diversity of the vagina with probiotics

We currently stock a practitioner-only probiotic supplement specifically for the treatment of female reproductive tract infections, including candidiasis. This supplement contains two probiotic strains – Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14, both of which have been shown in clinical trials to inhibit the growth of Candida albicans.

Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 have also been shown to disrupt genito-urinary biofilms which may assist in the prevention of recurrent thrush.

What other factors disrupt the stability of vaginal microbial communities? 

 

Sex hormones

The presence of glycogen within the epithelial cells of the vagina positively influences the presence of probiotic Lactobacillus spp. Lactobcillus spp. use glycogen as a source of energy and, through fermentation of glycogen breakdown products glucose and maltose, produce lactic acid. Oestrogen promotes the availability of glycogen to the epithelial cells. Therefore, throughout various stages of the cycle when oestrogen levels are low, glycogen becomes less available and numbers of lactobacilli decrease. Progesterone and oestrogen also play a role in the regulation of the pH of the vagina, therefore an imbalance of these hormones may create a more alkaline environment which is favourable for the overgrowth of Candida albicans. This is particularly important in individuals who are experiencing hormonal imbalances or women who are going through menopause, as oestrogen levels are naturally declining, resulting in a heightened susceptibility to infection.

 

Menses

Alterations to bacterial colonies within the vagina have been shown throughout the different stages of a woman’s cycle. During menses, a decrease in the number of beneficial lactobacilli, as well as disruption to remaining lactobacilli, has been shown in a number of longitudinal studies. Low levels of lactobacilli have also been reported in the phase immediately following menses. This means susceptibility to infection may be heightened at this time.

 

Sexual intercourse

Disruption to the numbers of lactobacilli has also been reported immediately following sexual intercourse, again increasing the opportunity for an overgrowth of pathogenic yeast. Other factors to take into consideration are the type of lubrication and contraception methods used. The majority of personal lubrication products on the market have a pH that is higher than the ideal range of the vagina and which can create changes to the vaginal environment. Furthermore, it is also important to take into consideration the osmolality of personal lubricant. The osmolality of a lubricant being too high or too low can cause damage to the epithelial cells of the vagina by causing them to either rupture or dehydrate. Damaged cells increase the risk of vaginal infection. It is recommended that the osmolality of personal lubrication should not exceed 380 mOsm/kg to prevent epithelial damage.

In clinic, we also see a number of preconception clients with vaginal infections such as thrush. Sexual practices, particularly when trying to conceive, can also impact on the pH of the vagina due to semen having an average pH of between 6–7, creating a less acidic vaginal environment which may promote thrush infection. This places emphasis on the importance of education when trying to conceive and knowing when you are most fertile to avoid disrupting the pH of the vagina during less fertile times in the cycle.  Avoidance of sexual practices during infection is also recommended.

 

Vaginal hygiene practices

The use of vaginal douches and intimate hygiene products has been shown to create alterations in the pH of the vagina, favouring conditions for the overgrowth of Candida albicans. Prolonged damp conditions have also been shown to contribute to the overgrowth of Candida albicans. Ensuring the external vaginal area is completely dry, through the avoidance of prolonged wearing of a wet bathing suit or damp or wet underwear, reduces the risk of infection. Ensuring that you wipe front to back after voiding the bladder or bowel is also important in preventing the translocation of microorganisms from the bowel to the reproductive tract.

It is also recommended that cotton underwear should be worn, that tight clothing is avoided and personal clothing should be washed in hot water and ideally separated from others.

 

Diet

There are also a number of dietary factors that impact on the growth of pathogenic yeasts within the body. Naturopathic consultation for the treatment of vulvovaginal candidiasis involves an extensive assessment of both dietary and lifestyle factors which may be contributing to a thrush infection, individual to each client.

If you would like more information on the dietary and lifestyle factors that contribute to thrush or other female reproductive infections, or you would like assistance in treating thrush naturally, book an appointment with our naturopath, Karly, by clicking here.

References:

Brooks, J. P., Edwards, D. J., Blithe, D. L., Fettweis, J. M., Serrano, M. G., Sheth, N. U., … Jefferson, K. K. (2017). Effects of combined oral contraceptives, depot medroxyprogesterone acetate and the levonorgestrel-releasing intrauterine system on the vaginal microbiome. Contraception, 95(4), 405–413. https://doi.org/10.1016/j.contraception.2016.11.006

Cassone, A. (2015). Vulvovaginal Candida albicans infections: Pathogenesis, immunity and vaccine prospects. BJOG: An International Journal of Obstetrics and Gynaecology, 122(6), 785–794. https://doi.org/10.1111/1471-0528.12994

Crucitti, T. (2017). Eve’s garden: myths, legends and secrets unmasked. Research in Microbiology, 168(9–10), 773–781. https://doi.org/10.1016/j.resmic.2017.07.004

Martins, N., Ferreira, I. C. F. R., Barros, L., Silva, S., & Henriques, M. (2014). Candidiasis: Predisposing Factors, Prevention, Diagnosis and Alternative Treatment. Mycopathologia, 177(5–6), 223–240. https://doi.org/10.1007/s11046-014-9749-1

O’Hanlon, D. E., Moench, T. R., & Cone, R. A. (2013). Vaginal pH and microbicidal lactic acid when lactobacilli dominate the microbiota. PLoS ONE, 8(11), 1–8. https://doi.org/10.1371/journal.pone.0080074

Tachedjian, G., Aldunate, M., Bradshaw, C. S., & Cone, R. A. (2017). The role of lactic acid production by probiotic Lactobacillus species in vaginal health. Research in Microbiology, 168(9–10), 782–792. https://doi.org/10.1016/j.resmic.2017.04.001

Smitten Kitten’s shopping guide to lube (2015)