A recurring yeast infection (vaginal thrush) is defined as an episode 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.
What is a recurring yeast infection?
A vaginal yeast infection (vaginal thrush) is an extremely common cause of vaginal discharge - up to 3 in 4 women will have at least one episode during their lives. In most cases, thrush in women settles with simple treatment, either topical (applied to the vagina in the form of pessaries or antifungal creams) or oral (a tablet or tablets).
However, some women either suffer repeated new infections, or find that they still have symptoms because the initial thrush treatment has not been effective.
How common are recurring yeast infections?
By Mikael Häggström, CC0, via Wikimedia Commons
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 poorly controlled diabetes) and women with weakened immune systems may be more likely to develop recurrent thrush, or other chronic yeast infections.
What causes recurring yeast infections?
There is some debate as to whether women taking hormone replacement therapy (HRT) or the combined oral contraceptive (COC) pill are more likely to develop a recurring yeast infection - the evidence is not yet clear.
Treating recurring yeast infections
If you have repeated (recurrent) bouts of thrush then one option is simply to treat each bout as and when it occurs, making sure you complete the full course of treatment. See the separate leaflet Vaginal Thrush (Yeast Infection) for treatments for thrush.
If you have four or more episodes of vaginal thrush a year, and your symptoms settle either completely or partially in between bouts, your doctor may suggest other options.
Before they do this, they may want to exclude another cause for your symptoms. This could include:
- Taking a vaginal swab and sending it the laboratory to check for evidence of thrush or other infection.
- Checking the pH (acidity level) in your vagina using a simple test strip. A lower pH (4.5 or below) makes it more likely that thrush is the cause. A higher pH (above 4.5) makes bacterial vaginosis (BV) or trichomonas infection more likely.
- Other swabs or tests as appropriate.
When your doctor has confirmed it is vaginal thrush they usually follow a treatment plan where they 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. This long treatment phase is called induction.
Whether you use topical or oral will depend on your age, preference, tolerance for the method and whether you are pregnant. Pregnant women should NOT take oral antifungal medicines.
- Topical treatment: Clotrimazole 500mg pessary every day for 10-14 days.
- Oral treatment: Fluconazole 150mg tablet every 3 days for 3 doses.
You then move onto the maintenance phase, where you take a regular dose of the same treatment to prevent the yeast infection returning.
- Topical treatment: Clotrimazole 500mg pessary once a week.
- Oral treatment: Fluconazole 150mg tablet once a week, or itraconazole 50-100mg tablet every day.
If you're 12-15 years old, or it's not clear whether your symptoms are due to recurrent vaginal thrush, your doctor may recommend a hospital specialist referral.
Most women remain clear of thrush during maintenance treatment. If you and your doctor decide maintenance treatment is best for you, this will usually last for six months.
After treatment is stopped, many women remain free of thrush, or only develop the occasional bout again. However, some women return to developing recurring yeast infections. If this happens, the treatment plan can be repeated, and maintenance treatment continued for longer.
When to seek further advice
In addition, you should speak to your doctor if:
- Your symptoms don't get better with treatment.
- 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.
- You become pregnant or are breastfeeding.
- You develop side-effects from the medication.
- You develop new symptoms, such as smelly discharge, ulcers or blisters, abnormal vaginal bleeding or a bloodstained discharge.
- You feel unwell in yourself.
Preventing recurring yeast infections
The yeast that causes yeast infections, called Candida spp., thrives in warm, moist, airless environments. General lifestyle changes that help prevent single episodes of vaginal thrush can also help reduce the risk of recurrent thrush.
- Avoid wearing tight-fitting and non-absorbent clothing that may irritate the area.
- Using simple emollients or soap substitutes to wash the vulval area.
- Avoid using potentially irritant products such as shampoos, shower gels, bubblebath or wipes.
- Avoiding vaginal douching.
If you have diabetes, your risk of recurring yeast infections 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 bouts of thrush.
If you experience recurring yeast infections, 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 vaginal thrush more likely. However, the evidence around this is a little unclear.
Further reading and references
Candida - female genital: recurrent infection; NICE CKS, July 2022 (UK access only)
Standards for the management of sexually transmitted infections (STIs); British Association for Sexual Health and HIV (2019)
Vaginal discharge; NICE CKS, January 2019 (UK access only)
Candida - female genital; NICE CKS, July 2022 (UK access only)