I am suffering from recurrent vaginal thrush. What to do?

Question

Hello doctor,

I had thrush a few weeks ago due to antibiotics. It subsided on taking cream and a pessary after which I stopped the cream in three to four days. After a few days, the thrush again appeared on my vagina (labia). Nurse in a walk said still there is thrush and advised to take Fluconazole and cream. So took one pill of Fluconazole and took cream for a week. However, the painful cuts are still there and itchy. I have got some pictures attached. Wiping hurts a lot because it is sensitive to the touch. I also have some similar cut near my butt hole.

Answer 1

Hello,

Welcome to icliniq.com.

These are definitely (attachment removed to protect patient identity) old thrush lesions which have become inflamed and red, due to possible frequent scratching following itching over the region. The scratching has possibly led to abrasions or knife-like cuts. They are likely to be painful and oozing if scratching continues. Instead of using Plan Canesten cream, use cream Canesten-s (which contains Clotrimazole 1 % with Beclomethasone 0.025 % w/v) and apply it overall knife cut lesions thrice a day for the next three days.

Beclomethasone is a steroid which blocks the production of certain chemical messengers (prostaglandins) that make the skin red, swollen, and itchy (often following scratching- vicious cycle). Clotrimazole is an antifungal that stops the growth of fungi on the surface by preventing them from forming their protective covering. Keep the local area as dry as possible throughout the day, especially post micturition, use soft cotton towels to dry (clean sheets regularly and use a fresh one each time as tissues can cause further abrasions. So do not wipe, just pat and dry). After that, you may apply an antifungal dusting powder (Canesten dusting powder) after application of the cream, over both vulvar and perianal region which shall help local moisture in check and allow lesions to heal. Please wear loose cotton undergarments to avoid any further frictional injury.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, you can use Candid -B cream. It has the same constituents. Use of steroids over genitals is harmful and a standard instruction overleaf, but you can use a short course for three days over the vulval, peri-vulvar and perianal region (which has stratum corneum as the skin top layer) and not vaginal or anal mucosa directly. So take care that you do not apply inside the vagina or anal canal. It is as similar to applying over skin externally. If Lotriderm is available as an over-the-counter (OTC) drug, then you can use that as well, just that the concentration of Beclomethasone is double. So practice twice a day application. And only externally and only for three days and then see the response.

Answer 3

Hello,

Welcome back to icliniq.com.

You may use petroleum jelly over the cuts in the meantime as it would layer the cuts and this would soothe the sensitivity. Aloe vera gel would only soothe for some time, and they shall dry and can cause further sensitivity so better avoid and use just plain petroleum jelly in the meantime and alternate it with Canesten cream.