Recurrent thrush is defined as an epsiode of thrush four or more times in a year. In some cases, there is a medical reason that you are more prone to thrush infection. Some hormone treatments may also affect your risk of repeated episodes.
Vaginal thrush is extremely common - up to 3 in 4 women will have at least one episode during their lives. In most cases, it settles with simple treatment, either topical (applied to the vagina in the form of pessaries or cream) or oral (a tablet or tablets). However, some women either suffer repeated new infections, or find that they still have symptoms because the initial treatment has not been effective.
What causes recurring thrush?
Of women who develop a first bout of vaginal thrush, about 5 in 100 of them will get problems with recurrent vaginal thrush. In most cases, the reason why this occurs is not known. Some women just seem more prone than usual to develop thrush. However women with high blood sugar due to uncontrolled diabetes and women with a poor immune system may be more likely to develop recurrent thrush. There is some debate as to whether women taking HRT or the COC pill are more likely to develop recurrent thrush - the evidence is not yet clear.
How do I treat recurring thrush?
If you have repeated (recurrent) bouts of thrush then one option is simply to treat each bout as and when it occurs. Read more about the treatments for thrush.
Another option that your doctor may suggest is as follows:
- Use one of the treatments described above (topical treatments or tablets) - but for longer than usual. Your doctor will advise exactly how long to use the treatment for. For example, this may be for 10-14 days for topical treatments.
- Then use a topical treatment or take a fluconazole tablet once per week. (Sometimes other tablets may be prescribed; follow the instructions given by your doctor.) This is called maintenance treatment, which often prevents thrush from coming back.
- Continue maintenance treatment for six months and then stop.
Most women remain clear of thrush during maintenance treatment. After treatment is stopped, many of those treated remain free of thrush, or only develop the occasional bout again. However, some women return to developing recurrent thrush. In such cases, if necessary, the treatment plan can be repeated, and maintenance treatment continued for longer.
See your doctor if you develop thrush whilst on maintenance treatment. This may indicate that you have a resistant strain of Candida spp. which may require an alternative treatment.
Can I prevent recurrent thrush?
The yeast that causes thrush, Candida spp., thrives in warm, moist, airless environments. General lifestyle changes that help prevent single episodes of thrush can also help reduce the risk of recurrent thrush.
If you have diabetes, your risk of recurrent thrush is higher if your blood sugar is consistently high. Working with your diabetes team to bring your blood sugar under control can cut the risk of recurrent thrush.
If you have recurrent thrush, your doctor or nurse may also discuss your current method of contraception with you and suggest a change. There has been talk in the past about the combined oral contraceptive (COC) pill (the pill that contains both oestrogen and progesterone hormones) possibly making recurrent thrush more likely. However, the evidence around this is a little unclear.
Further reading and references
Management of bacterial vaginosis; British Association for Sexual Health and HIV (May 2012)
Management of Vaginal Discharge in Non-Genitourinary Medicine Settings; Faculty of Sexual and Reproductive Healthcare (Feb 2012)
Vaginal discharge; NICE CKS, May 2013 (UK access only)
Bacterial vaginosis; NICE CKS, July 2014 (UK access only)
Management of trichomonas vaginalis; British Asociation of Sexual Health and HIV (Feb 2014)
Gonorrhoea; NICE CKS, May 2017 (UK access only)