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Managing persistent thrush

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Persistent vulvovaginal candiasis, or recurrent thrush, is defined as the occurrence of four or more episodes of thrush within a year. Persistent thrush is caused by a fungal infection called Candida albicans. This is said to be the causative organism in 80-92 per cent of cases. Other causes are C. glabrata, C. tropicalis, C. parapsilosis, C. krusei, C. kefyr, C. guilliermondii, and Saccharomyces cerevisiae.1

Susan was a 42-year old patient who attended my surgery, initially stating she had a probable urine infection. Initially, she was reluctant to describe her symptoms. Susan had visited the surgery for a smear test two years previously and had found the examination stressful.

She had a body mass index (BMI) of >30 kg/m2 and was worried a comment would be made about her weight. Susan thought that she may have a yeast infection or thrush, and that this was as a result of her weight. During the current consultation, we were able to discuss her symptoms and look at the possible causative factors for them.

Medical history

Susan had rarely attended the surgery in the past, apart from routine cervical screening and family planning. She had two children aged 12 and 10 years. In her second pregnancy, she had developed gestational diabetes.

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