Diagnosis
Symptoms of thrush can include:
- A thick, white vaginal discharge
- Vulval and vaginal itching
- Redness, soreness and swelling of the vulva and vaginal walls
- Burning or stinging of the vulva when passing urine due to inflammation and cellular damage caused by the infection
- Pain during sexual intercourse.
The usual sign of vaginal thrush is a discharge which is whitish, thick and curd-like. However, the discharge is not always present and frequently can be minimal.
Whilst thrush is an infection that starts internally, women may only experience the external symptoms of vaginal itching and irritation. Acute external itch is therefore the main presenting symptom, which occurs as the result of an allergic-type reaction to candida in the vaginal wall, causing the release of histamine. Vaginal soreness and irritation, vulval burning, dyspareunia as well as dysuria are also common symptoms.
Examination frequently reveals erythema and swelling of the labia and vulva, often with separate pustulopapular peripheral lesions. The cervix is normal, and mucosal erythema is present together with adherent whitish discharge.
Microscopy and speciated fungal culture of vaginal secretions to identify yeasts is recommended for:
- Supporting the diagnosis when this is uncertain.
- Severe vulvovaginal candidiasis.
- Treatment failure.
- Recurrent vulvovaginal candidiasis.
- Consider additional tests such as full blood count and random blood glucose if recurrent vulvovaginal candidiasis, depending on clinical judgement.
