STD Awareness: Is Bacterial Vaginosis a Sexually Transmitted Disease?

Vaginal Thrush: What's Up 'down There'?

There are a number of myths circulating about vaginal thrush - like that a lack of hygiene is the cause or that yoghurt-dipped tampons are a home remedy. Here's what every woman should know about this common cause for itching and burning. Christin Klose/dpa

With symptoms that include itching and burning, vaginal thrush is no fun. Many women are understandably reluctant to talk about it, although medical experts say that three out of four get it at least once in their lifetime.

Also called vaginal yeast infection or vulvovaginal candidiasis, vaginal thrush is caused by an overgrowth of candida, a type of yeast, which is a type of fungus.

The most prevalent microorganisms in a healthy vagina, lactobacilli, create a mildly acidic environment that inhibits the proliferation of pathogens. When the natural balance of bacteria and yeast is disrupted, infections can occur.

Two gynaecologists explain how thrush can develop and how it's treated:

What causes vaginal thrush?

Candida are commonly found in the vaginas of sexually mature women. In fact, 30-60% of all healthy people have them on the mucous membranes of their genitals, mouth and throat, and gastrointestinal tract, according to Dr Werner Mendling, director of the German Centre for Infections in Gynaecology and Obstetrics at Helios University Hospital in Wuppertal, Germany.

The presence of candida isn't due to poor hygiene, he remarks, but says they can be spread from one person to another by kissing someone with oral thrush and by oral sex.

While the overwhelming majority of people colonized by candida show no ill effects, this can change with antibiotic use, for example. Antibiotics not only kill pathogens, but also attack the beneficial lactobacilli in the vagina and can make them unable to maintain its pH around 4 and keep candida under control.

"Someone who's generally ill and has a weakened immune system is also more susceptible to yeast infections," Mendling says, adding that stress, too, can encourage an infection. "Candida that have colonized the vagina or penis asymptomatically can then suddenly cause problems."

Some women are more prone to vaginal thrush than others. It's especially common in women of childbearing age, and genetic predisposition may play a role as well.

What doesn't play a role are tampons, Mendling says: "Tampons have no effect on vaginal flora and can be [safely] used, just as menstrual cups can."

What are the symptoms of vaginal thrush?

"Typical symptoms of infections in the genital area are irritation and pain along with itching and redness," says Dr Cornelia Hösemann, executive committee member of Germany's Professional Association of Gynaecologists (BVF).

In addition, there's often a discharge "unlike your normal vaginal discharge, as its consistency, colour or smell differ," she points out. In the case of vaginal thrush, it's usually cottage cheese-like, and yellowish-whitish or pale. Lower abdominal pain can occur as well.

Itching isn't necessarily an indication of a yeast infection, since it's also a symptom of other illnesses of the genital area. "And sometimes thrush doesn't alter the vaginal discharge and you can't discern anything unusual about it," says Mendling.

As a general rule, women should see a gynaecologist whenever they experience itching, burning, pain, an unpleasant odour or other symptoms in their genital area.

Why is it so important to go to a doctor with your complaints?

Consulting a doctor is important in part because there's a lot of misinformation about vaginal yeast infections in circulation. Mendling advises against simply going to a pharmacy and picking up a medication, because a yeast infection isn't always to blame for itching in your genital area.

"And if you really do have a yeast infection, it's important to determine what type of yeast it is, since the treatment depends on it," Mendling says. Different yeasts have to be treated differently.

So a diagnosis should be verified by a gynaecologist. It's possible that bacteria are causing the symptoms - an infection called bacterial vaginosis - in which case the gynaecologist will prescribe an antibiotic.

While vaginal infections are unpleasant, they're usually comparatively harmless, says Hösemann. In rare cases though, they can signal something serious, such as a sexually transmitted disease (STD). For this reason alone, she says you shouldn't practice self-treatment, "especially if the symptoms don't go away or even worsen."

How is vaginal thrush treated?

The doctor will normally prescribe antifungal tablets or suppositories. If the symptoms, such as itching, continue after three days of treatment, you should see your doctor again for further help.

Do tampons soaked in yogurt help by putting beneficial lactobacilli back into the vagina? Hösemann says she can't recommend this home remedy, as the lactobacilli in yogurt differ from those that colonize the vagina and therefore have no impact on vaginal health.

She also discourages home tests for STDs without lab analysis, noting they can be unreliable and provide false results.

Are people who use tampons more likely to get vaginal thrush? Gynaecologists say this isn't true. Zacharie Scheurer/dpa

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Winning The Battle Against Thrush

Start most women off on the subject of vaginal thrush, and they'll tell you that it can be one of the most irritating and troublesome conditions that a woman can experience.

And although some women endure only the odd bout, the lives of others are blighted by its stubborn recurrence.

The symptoms of thrush include vaginal itching, a thick, white discharge, swelling of the vulva, pain or soreness during intercourse and the need to urinate more often than usual, while some women also complain of extreme fatigue, feelings of depression and irritability, skin rashes, digestive problems and headaches.

Many cases of thrush are caused by the excessive growth of the Candida albicans fungus, a micro-organism that is commonly found on the skin and in the mouth, digestive tract and vagina, but whose numbers are normally kept at an undisruptive level by harmless bacteria.

Sometimes, however, the vagina can become overloaded with C. Albicans, prompting the symptoms of thrush to kick in, particularly after a course of antibiotics has zapped some of your body's good, defensive bacteria along with their unwanted pathogenic counterparts, after sex, during pregnancy or when you're on the pill (when the vagina's hormonal environment changes), or when your immune system is weak, perhaps following an illness.

The nutritional treatment of thrush is a controversial subject. Because some doctors, for example, are sceptical that C. Albicans can cause any adverse symptoms, they dismiss the notion of tackling it with a special diet.

As a nutritional practitioner who has treated a large number of women whose symptoms have been eased by a diet designed to decrease the growth of the culprit fungus, however, I have to disagree.

So what can you do to banish thrush? Speaking from experience, I'd recommend that you tackle two core issues: firstly, increasing the levels of C. Albicans-combating, probiotic bacteria within your body, and, secondly, starving the C. Albicans bacteria of their main sources of food, namely sugar and alcohol.

Probiotic bifido or lactobacilli bacteria, which are important components of the vagina's normal bacterial population, produce acids and antibiotics that make it hard for other micro-organisms, C. Albicans included, to thrive.

Although eating, or coating the vagina with, live yoghurt containing these good bacteria can be quite helpful in tackling thrush, it is not as effective as using a pessary containing either lactobacilli or an oligofructose prebiotic, which acts as both a cure and a preventative (consult your doctor about these treatments, as well as about taking a course of capryllic acid, a natural anti-fungal substance).

Together with including pro- or prebiotic bacteria in your daily routine (and I'd anyway recommend having a small pot of live yoghurt a day to maintain the health of your gut), try to avoid foods that contain high concentrations of sugar, notably such blatantly sweet products as cane sugar, honey, syrup, sweet drinks, cakes, biscuits and chocolate, and instead boost your intake of fresh fruits, vegetables, beans, lentils, lean proteins, oats, wholemeal bread, pasta, potatoes and rice.

Avoid alcohol for a few weeks, too, because it not only increases the concentration of sugar in the urine, so feeding the bad bacteria, but also contains yeast.

Because the evidence that thrush can be cured by avoiding yeast-containing foods (bread, Marmite, blue cheeses and mushrooms, for instance) is inconclusive, however, I'd advise simply minimising your intake of these and instead focusing on cutting sugary foods from your diet.

These twin strategies aside, remember that it's important to keep your immune system strong by having a well-balanced diet that includes oily fish (such as sardines, tuna, salmon, herrings and mackerel), studies also having indicated that the eicosapentaenoic acid that they contain seems to reduce inflammation and boost the body's immunity.

Finally, because garlic contains allicin, a potent combatant in the battle against yeast infections, try to have a couple of small cloves of raw or cooked garlic a day.

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RECIPE: New potatoes and garlic baked in a parcel

Each parcel serves 1 person

4 to 6 new potatoes, weighing about 100g in total

5 cloves garlic, unpeeled

5cm piece of lemon grass, peeled (optional)

small bunch thyme

sea salt

freshly ground black pepper

1 tablespoon olive oil

Wash the potatoes, but leave their skins on. If they measure 2.5cm or less in width, leave them whole, otherwise cut them into roughly equal-sized pieces.

Preheat the oven to 200C. Take a sheet of baking paper measuring approximately 28 x 48cm and fold it in half. Now open up the paper and place the potatoes on the lower half. Add the garlic, lemon grass (if you are using it), thyme, a little sea salt and plenty of freshly ground black pepper and drizzle over the olive oil.

Fold the top section of the baking paper over the potato mixture and then tuck in and twist the edges to make a sealed parcel.

Place the potato parcels in the oven and bake them for 30 minutes. Remove the parcels from the oven, transfer them to serving plates and serve them immediately, while scented steam is still wafting from them.

You can also bake young carrots, leeks, beans and beetroots in this way, but remember that you will need to adjust the cooking times to suit their size.

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What Causes Yellow Vaginal Discharge And How Is It Treated?

Discharge is normal for all women so it's likely you'll be acquainted with what yours usually looks like. But if you're looking down and seeing yellow discharge, how concerned should you be?

Well, first up, know that the NHS says 'clear and white' discharge is normal. Any discharge other than that, such as pink discharge or yellow discharge, might have an underlying cause that needs addressing.

'Normal vaginal discharge can vary in colour from clear to milky white,' says Valentina Milanova, a women's health expert and founder of leading gynaecological health company Daye. 'The hue and consistency may change based on the individual's menstrual cycle, hormonal changes, or activities like sexual intercourse. Normal vaginal discharge usually has an inoffensive odour and the consistency can range from thin and sticky to thick and gooey depending on where you are in your menstrual cycle.'

What is yellow discharge?

Discharge is a fluid or mucus that keeps the vagina clean and moist, and protects it from infection. 'First, there is a wide variation in the normal, and many of the symptoms associated with vaginal abnormality are found in well women,' write the authors of a research paper looking at whether vaginal symptoms are ever 'normal'. They noted that, in some cases, yellow discharge was seen in up to 10% of women.

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However, the colour of our discharge often indicate what's going on in our reproductive organs. 'Maintaining a healthy vagina is down to millions of different types of microbes called bacteria which are collectively called the vaginal microbiome. Unlike the gut microbiome which thrives on many different types of bacteria, it is accepted that the vaginal microbiome depends on a small number of friendly bacteria known as lactobacilli which protect vaginal health,' says consultant gynaecologist Dr Jo Bailey.

'Yellow discharge can be a sign that something isn't quite right - that there is an imbalance, and this can be due to a number of different things.'

Is yellow discharge normal?

'Yellow discharge can be seen as a variation of normal discharge, especially if it's light in colour and not accompanied by other symptoms,' says Milanova. However, 'if the discharge is a darker yellow or green-tinged, especially if it's thick, chunky, or accompanied by a foul odour, it could be a sign of an infection.'

'Yellow discharge can be a sign that something isn't quite right'

What causes yellow discharge?

Typically, yellow discharge is associated with bacterial vaginosis (BV) - an imbalance of bacteria in the vagina - or trichomoniasis, an infection caused by the passing of a parasite during sexual contact.

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'BV is the most common cause of vaginal discharge in women aged 15–44 years old. Some women mistake it for thrush so it's important to get a proper diagnosis. It is not classified as a sexually transmitted infection and may occur for all sorts of reasons, such as having an IUD fitted or leaving tampons in for too long,' says Dr Bailey.

The main symptoms which distinguish a yellow discharge from BV are its distinct 'fishy' odour, an abnormal discharge, usually white or grey, and discomfort, soreness or itching, Dr Bailey explains.

What STD has yellow discharge?

Other possible causes include chlamydia and gonorrhoea, says Milanova. Studies suggest that around 50% of women with chlamydia have yellow discharge, so if you have yellow discharge it's vital to get checked.

How long does yellow discharge last?

If your yellow discharge is a result of an STD, BV or thrush, it will last until you seek treatment. 'If your discharge has a slight yellow tinge, common with ovulation, it will last for a day or so. If it lasts longer than five days, see a doctor,' says Dr Bailey.

When should you see a doctor about yellow discharge?

'You should see a doctor if you have yellow, green, or foul-smelling discharge, especially if accompanied by itching, burning, pelvic pain, fever, or painful urination,' says Milanova. 'Getting tested and properly treated is important, as untreated infections can lead to serious complications like pelvic inflammatory disease. Additionally, if you've tried managing it at home without improvement or if you're concerned for any reason, seeking medical advice is always a good step.'

How to treat yellow discharge?

Managing yellow discharge starts with understanding its cause. For mild cases without other symptoms, maintaining good vaginal hygiene and wearing breathable cotton underwear may help balance the microbiome and prevent any longterm discomfort.

'Avoid douching or using scented products, as these can disrupt the natural balance of bacteria in the vagina. If the discharge is due to an infection, treatment will depend on the specific cause, such as antibiotics for bacterial infections or antifungals for yeast infections,' says Milanova. Dr Bailey adds: 'There is good evidence that taking a probiotic with the correct species and strains of Lactobacillus will support your vaginal microbiome, too.'

For anyone concerned about yellow discharge, talk to your GP. You can also try Daye's diagnostic tampon which can spot and diagnose STDs and other infections at yourdaye.Com.

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