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Assessing and managing thrush

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It is common for women of child-bearing age to present in general practice with vaginal discharge.

The second most common cause of infective vaginal discharge is Candida albicans, a commensal organism that may be found in up to 20 per cent of women. In the majority of cases, acute vulvovaginal candidiasis, or thrush, is caused by an overgrowth of C albicans, although non-albicans species such as C glabrata could be the cause. Thrush may present with a non-offensive white discharge with itching. Vaginal pH is typically less than 4.5.1

Clinical assessment

It is important to consider whether an STI may be responsible in a woman presenting with vaginal discharge. When taking a history, it is helpful to evaluate whether any treatments have already been tried and their effect.

Patients may report vulval erythema and swelling. Discharge usually occurs in the presence of vaginal erythema. This discharge is typically curdy, but may be thin. There may be superficial dyspareunia and/or dysuria. On examination, there may be evidence of excoriation and satellite lesions.1

Vulvovaginal candidiasis may occur more frequently in women aged twenty to thirty, in those with diabetes, in the immunocompromised and during pregnancy.

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