Comprehensive treatment of chronic thrush. How and how to treat thrush in women: drugs, features of use

Treatment of thrush in women depends on the manifestations: vulvar candidiasis, vaginal candidiasis, candidal vaginitis and vulvovaginitis. Depending on the severity and form, thrush in women is manifested by white curdled discharge, edema, and hyperemia. Sometimes white plaques may appear on the vaginal mucosa. In advanced cases, plaques appear on the cervix. Usually at this stage of development, the disease is manifested by damage to the perineum and inguinal folds.

If a common thrush appears in women, the treatment consists in prescribing local antimycotic agents. Treatment of candidiasis in women, which is accompanied by inflammation of the vulva and vagina, consists of several stages. Patients are prescribed vaginal cream Butaconazole (Clotrimazole, Miconazole). If candidiasis in women recurs (photo), and the treatment does not give a positive result, antimycotic drugs are prescribed orally.

Usually, vaginitis and vulvovaginitis begin to appear a few days before the onset of menstruation. With the appearance of burning and pain, itching during urination and discharge caused by candida, treatment in women should begin immediately after laboratory confirmation of the diagnosis.

Reasons for ineffective treatment

Sometimes with prolonged use of certain antimycotic drugs, strains of candida appear in the body that are resistant to drugs. In such cases, the treatment of female thrush is corrected and other drugs are prescribed. Frequent relapses of the disease require maintenance therapy.

The victory over the fungus is not always explained by the fact that women often prescribe treatment for themselves, not taking into account that in the body there are varieties of candida strains with different sensitivities to antifungal drugs. Therefore, before treating female thrush, it is necessary to pass tests for sensitivity to antimycotic drugs. Only in this case can positive results be expected.

The cause of frequent relapses can also be the banal abuse of antibiotics and hormonal drugs. Careless attitude to your diet, constant stress can also upset the natural balance of immune processes, which leads to the growth of the fungus. In such cases, the candida fungus becomes aggressive and in women, treatment can be delayed for a long time.

Treatment regimens for thrush in women

With a disease not complicated by a secondary infection, the treatment regimen for candidiasis in women consists in administering Butoconazole cream into the vagina for three days at night. If strains of the fungus are sensitive to Clotrimazole, Clotrimazole vaginal cream is prescribed. Depending on the symptoms, the use of the cream can last from 7 to 14 days. The course of treatment of thrush in women with Clotrimazole may vary. When prescribing the drug in the form of vaginal tablets, the duration can vary from 1 to 7 days, depending on the dosage of the drug.

The use of Miconazole cream reduces the duration of antimycotic therapy to 3 days. Quick Treatment thrush in women - a single injection of Thioconazole ointment into the vagina or taking high-dose antimycotic drugs orally. In connection with the advent of new drugs, other methods of treating thrush in women have appeared. With recurrent vulvovaginal candidiasis, a single oral dose of Fluconazole (150 mg) or a double dose of Itroconazole (100 mg per dose) is prescribed. At the same time, a high-dose vaginal tablet (Fluconazole 500 mg) is administered. This scheme is carried out once a week until the symptoms disappear.

With HIV infection, resistance to fluconazole therapy is observed. For severe cases, treatments for thrush in women include the potent drug Amphotericin B in liposomal form. Effective treatment thrush in women is based on the severity clinical symptoms and includes the use of various groups of drugs. The oral regimen for acute candidiasis is the use of Natamycin (400 mg) for 10 days, Fluconazole (Diflucan, Medoflucon) - either once in a high dose or throughout the week in small dosages.

To prevent relapse, a single dose of high-dose fluconazole (150 mg) is used on the first day of menstruation for three consecutive cycles. When a mixed infection is confirmed (gardnarella, Trichomonas, etc.), a complex treatment of thrush in women is prescribed. After antifungal and antibacterial therapy, eubiotics (Bifidumbacterin, Acilact) are prescribed, which help restore normal microflora. With frequent relapses, physiotherapeutic procedures that restore immunity (darsanval, magnetotherapy, electrophoresis, etc.) are useful.

How to treat candidiasis?

In medicine, the treatment of thrush in women, both local and oral, is used. Topical medicines include various creams, vaginal tablets, suppositories and ointments. Topical preparations are the best choice for gentle therapy. Their use does not have a systemic effect on the body. Therefore, such drug treatment thrush in women can be carried out at home. Local drugs successfully treat uncomplicated candidiasis or its mild forms. In chronic thrush, tablets are prescribed in combination with local drugs.

If thrush is recurrent, treatment in women includes systemic tablets that affect the entire body. The active substances of the drugs fall not only into the focus of infection, but also into other systems and organs. For effective fight with candidiasis, antifungal drugs are prescribed, based on the results of crops on the sensitivity of candida colonies to the active substance. Fungal strains in chronic forms of candidiasis may be more resistant to antimycotic drugs than candida, which causes acute common thrush. That is why it is so important to conduct a bacterial culture.

Thrush, or vulvovaginal candidiasis, is an inflammatory process caused by yeast-like fungi of the genus Candida. These infectious agents are opportunistic pathogens and are normally always present in the intestinal and vaginal microflora. However, with a decrease in immunity and other adverse factors, they can begin to actively multiply. This process is accompanied by the appearance of itching, redness, irritation and curdled discharge on the mucous membranes of the genital organs, which causes a woman severe discomfort and a desire to get rid of them as soon as possible.

Content:

Types of drugs for the treatment of thrush

If symptoms of thrush are found, you should consult a doctor and pass the tests necessary to confirm the diagnosis. A wide range of remedies for thrush that exist today, as well as their active advertising, promising to cure the disease forever after taking one pill, often misleads women. This contributes to improper self-prescribing of drugs, delaying recovery, the transition of the disease to a chronic form, and even the development of complications.

Before starting to treat thrush, it is important to perform a culture of a swab taken from the genitals of a woman, to accurately identify the causative agent of the disease and determine its sensitivity to the available antimycotic active ingredients. In most cases, the cause of thrush is the fungus Candida albicans, but there are other fungi of this genus that can cause an inflammatory process on the external and internal female genital organs. For example, Candida glabrata, which are more resistant to most of the antifungal drugs used. Only a doctor will be able to choose the right medicines and treatment regimen, taking into account contraindications, the age of the patient, and the presence of other concomitant diseases.

Medicines for the treatment of thrush in women can be local or systemic. They are found under various trade names, but they include active substances in two main groups:

1. Azole derivatives - fluconazole, clotrimazole, miconazole, ketoconazole, itraconazole, econazole, sertaconazole, fenticonazole, isoconazole. They have fungistatic (slowing down the growth of fungi) and, to a lesser extent, fungicidal activity (completely destroying fungi). The mechanism of their action is associated with the inhibition of fungal enzymes necessary for the synthesis of ergosterol - the main structural component fungal cell membrane. As a result, the permeability of cell membranes increases, which leads to lysis of the fungal cell.
2. Polyene antibiotics - levorin, nystatin, natamycin. The mechanism of action consists in strong binding to ergosterol, disruption of the integrity of the fungal cell membrane, loss of compounds important for the existence of the cell and its subsequent lysis.

Local preparations are available in the form of vaginal suppositories, capsules or tablets, creams, ointments. They are used alone for mild forms of the disease and the absence of complications or as part of complex therapy with antifungal agents for oral administration at severe course thrush.

Systemic drugs are available as capsules or tablets for oral use. They have an effect on the entire body, including the focus of inflammation. Such funds are used in the chronic form of the disease, accompanied by frequent relapses, as well as in acute primary candidiasis with a severe course.

Principles of treatment of thrush

After the therapeutic course prescribed for thrush (not earlier than 2 weeks after its completion), a microscopic examination of a vaginal smear should be repeated to monitor the effectiveness of the therapy. If during treatment a woman experiences any side effects or an allergic reaction, you should immediately consult a doctor.

Treatment chronic thrush, when the characteristic symptoms of the disease appear more than four times a year, is a more complex process than the acute form. The most effective is an integrated approach that includes the treatment of concomitant diseases that contribute to the development of candidiasis (diabetes mellitus, chronic infections, hormonal imbalance), and the following: medicines:

• antifungal drugs of local and systemic action;
• probiotics that normalize the intestinal microflora;
• means for restoring the microflora of the vagina (acylact, bifidumbacterin, vagilak, lactonorm, vagiflor, gynoflor);
• anti-inflammatory drugs;
• drugs that strengthen the immune system;
• vitamin and mineral complexes for general strengthening of the body.

Treatment of chronic thrush takes several months. After its completion, maintenance therapy is prescribed to prevent exacerbations. It may consist of intermittent (once a week) use of antimycotic vaginal suppositories and oral tablets (once a month or more often).

Systemic drugs

Of the systemic agents for thrush, a woman is most often prescribed tablets or capsules containing fluconazole at a dosage of 50, 100 or 150 mg. These include:

• flucostat;
• diflucan;
• mycosist;
• mycomax;
• ciscan;
• diflazone;
• fucis.

In the acute form of thrush, for the disappearance of unpleasant symptoms, a single dose of fluconazole at a dose of 150 mg is sufficient, which is associated with a long-term preservation of high concentrations of the active substance in the blood plasma.

In addition to fluconazole, preparations based on itraconazole (irunin, orungal, itrazol, rumikoz, canditral), ketoconazole (nizoral, mycozoral, fungavis, oronazole), nystatin and natamycin (pimafucin) can also be used for systemic use.

A significant drawback of all these drugs, despite their high efficiency, is the inability to use for the treatment of thrush in pregnant and lactating women, a large list of contraindications and side effects, among which:

• disorders of the digestive tract (nausea, diarrhea, flatulence, pain in the abdomen);
• toxic effects on the liver and kidneys;
• headaches and dizziness;
• high risk of developing an allergic reaction.

Seizures and other neurological reactions may develop.

Topical preparations

Among the local drugs for the treatment of thrush, they are mainly used vaginal suppositories or tablets. They are inserted into the vagina in the supine position and bent knees with a finger or with a special applicator once or twice a day. In some cases, along with them, the application of antifungal ointments or creams to the external genitalia and washing or douching with special antiseptic solutions (cyteal) are simultaneously prescribed.

The main advantage of local remedies is the minimum number of possible side effects and contraindications, as well as a direct effect on the focus of infection. The disadvantages include some inconvenience in use: the need for a woman to be in a horizontal position for 20–30 minutes after the administration of a tablet or suppository, which is not always possible, a high chance of staining underwear or sheets with the resulting suppository residues even if daily pads are used.

Local therapy for infectious inflammatory diseases The female reproductive system not only allows you to destroy pathogens, but also inevitably leads to an imbalance in the beneficial microflora of the vagina and a decrease in local immunity. If not produced fast recovery lactoflora, activation of conditionally pathogenic microflora is possible, which will lead to an exacerbation of thrush or bacterial infections. For the same reason, antifungal therapy for vaginal candidiasis may not be effective enough. Therefore, after the first stage of treatment aimed at eradicating the infection, it is important to carry out the second stage - to restore the balance of beneficial microflora with the help of Lactoginal capsules. It is the only registered in the territory Russian Federation tribiotic drug. Lactoginal quickly restores pH, vaginal microflora and protects against re-aggravation of bacterial vaginosis and thrush for a long time. Two-stage therapy has recently become the gold standard for the treatment of conditions accompanied by pathological discharge. Many experts are confident that only this method can provide a pronounced and long-term therapeutic effect, strengthen local immunity, which serves as a prevention of subsequent exacerbations. one

Preparations based on clotrimazole

This group of medicines for thrush includes:

• tablets, cream or vaginal suppositories "Clotrimazole";
• cream and vaginal tablets "Kanesten";
• cream and vaginal tablets "Kandibene";
• cream and vaginal tablets "Antifungol";
• vaginal tablets "Candide B6".

Clotrimazole, when applied topically, penetrates well into tissues. With thrush, it is used at a dosage of 100 mg, 2 tablets per day for 3 days or 1 tablet per day for 6 days. It is effective not only against a wide range of fungi, but also against gram-positive and gram-negative bacteria, Trichomonas.

Clotrimazole is contraindicated in women in the first trimester of pregnancy, during menstruation and with hypersensitivity to the active substance.

Drugs with nystatin

Most well-known representatives of this group, used in gynecology, are suppositories and ointment "Nystatin", vaginal tablets "Terzhinan" and vaginal capsules "Polygynax". They are contraindicated in women during pregnancy and individual intolerance. The advantage of nystatin is that the fungus does not develop resistance to it. They need to treat thrush for at least 7 days.

Suppositories "Nitstatin" are available in a dosage of 250,000 or 500,000 IU. Terzhinan vaginal tablets are a complex antimicrobial and antifungal agent. In addition to nystatin, it contains the antibiotic neomycin, the anti-inflammatory drug prednisolone, and the active compound ternidazole against anaerobic flora. Polygynax is also a complex preparation consisting of nystatin and two antibiotics (neomycin and polymyxin B).

Means based on miconazole

Miconazole for local application used in the form of a cream and vaginal suppositories. Suppositories with dosage active ingredient 100 mg is used for thrush 1 time per day. The course of treatment is more than two weeks. On the basis of miconazole, a number of antifungal agents are produced, additionally containing metronidazole, which has antibacterial and antiprotozoal activity. These include vaginal suppositories "Klion-D 100", "Neo-Penotran", "Metromicon-Neo". Analogues of miconazole include cream and suppositories "Ginezol 7", "Gino-Daktarin".

Medications with ketoconazole

Ketoconazole and its well-known analogue livarol for thrush are used for 3-5 days at a dosage of 400 mg, 1 suppository per day, which is administered at night. They can be used in both acute and chronic forms of candidiasis, with mixed fungal-bacterial infections, disorders of the vaginal microflora.

Pimafucin

To treat thrush, a drug with a polyene antibiotic natamycin, Pimafucin, is widely used. It is available as oral tablets, vaginal suppositories, and cream. Pimafucin is well tolerated, non-toxic, can be used for women during pregnancy at any time and during lactation. The dosage of the active substance in suppositories is 100 mg, they are used once a day at night for 5-8 days.

Lactoginal

One of the most important areas of treatment of inflammatory diseases of the female reproductive system is the destruction of pathogens. Such therapy inevitably provokes a violation of the natural balance of the vaginal microflora, a weakening of local immunity, and, as a result, the development of thrush (vaginal candidiasis) or other fungal and bacterial infections. That is why it is important to restore the normal lactoflora of the vagina as soon as possible.

After the first stage of treatment, the purpose of which is to destroy the infection, as a rule, the second is prescribed - restoring the balance of beneficial bacteria with the help of special preparations. One of them is the drug Laktozhinal, the only tribiotic drug officially registered in the Russian Federation today. Laktozhinal restores the vaginal microflora and the normal acid-base balance of the mucosa, preventing the development of vaginosis and candidiasis.

Such two-stage therapy has recently been considered the gold standard for the treatment of infectious and inflammatory diseases of the genitals. Experts say that this method gives a long-term therapeutic effect, strengthens local immunity and prevents new exacerbations.

When treating thrush, to speed up recovery and reduce the growth of pathogenic flora, a certain diet should be followed. Need to exclude:

• sweets (cookies, sweets, chocolate), including sweet fruits and fruit juices;
• white bread, muffins, pasta, premium wheat flour products;
• products containing yeast;
• spices, spices, spicy dishes.

Unsweetened fermented milk products (yogurt, kefir, yogurt) containing live cultures of beneficial bacteria are recommended. They will contribute to the formation of a healthy intestinal and vaginal microflora and prevent the reproduction of the fungus.

In order to successfully treat thrush, great importance has the right choice of underwear, panty liners and cleansers. Briefs must be made of natural cotton fabric and have a "classic" shape. Beautiful, lacy, but made of synthetic, breathable fabric, thongs will help create a greenhouse effect, additional irritation and mechanical injury to inflamed tissues.

Panty liners used should be fragrance-free, as should intimate hygiene. This will help prevent the development of an allergic reaction. For washing or douching with thrush, after consultation with the doctor, you can use herbal infusions of chamomile, oak bark, calendula, sage, which have an antiseptic and healing effect. You need to wash yourself with thrush often.

1. There are contraindications. Before use, consult your doctor.

Video: About thrush and how to treat it

Thrush is one of the most common fungal diseases of the genital organs. Many women encounter it repeatedly, and those who have never had candidiasis have probably heard about it.

In medicine, the disease is called candidiasis and belongs to the category of infectious diseases.

Carriers of thrush can be not only women, but also men, but the latter have its hidden symptoms, the fair sex candidiasis causes a lot of trouble.

In order for the disease not to give complications after a while, not to develop into a chronic form and not to recur, you need to know how to treat thrush correctly and how much time and money it will take to overcome it forever.

Symptoms and Causes

The appearance of itching, white curdled discharge are the first and most unpleasant signs of candidiasis. However, such pronounced symptoms may not appear immediately, since the initial stage of infection is hidden, and its presence can only be determined through special analysis(smear).

The further course of the disease leads to the formation hyperacidity on mucous membranes, which irritates, injures tissues.

If you do not take measures for timely treatment, then after a while there are pain during urination and burning, the question arises of how to get rid of thrush.

The causes of thrush may be different:

Faced with candidiasis once, it is quite difficult to get rid of it, and some women even wonder if it is possible to cure thrush completely.

This is due to the fact that when treated improperly, the likelihood of relapse is exceptionally high.

That is why in the fight against candidiasis, a competent, effective approach is important with the use of appropriate medications and taking into account recommendations on how to properly treat thrush, what drugs and how long the course of admission should last.

What pharmaceutical preparations to use?

For the treatment of candidiasis, external medications (creams, ointments, sprays, gels), vaginal tablets (candles), tablets (capsules) for oral administration are used. Depending on the stage of development of the disease, the presence of relapses, the patient is prescribed appropriate drugs.

Medicines for external use: ointments and suppositories

Medicines for external use do not have a detrimental, systemic effect on the body, are not absorbed into the bloodstream, but act exclusively on the focus of infection. Among the most commonly prescribed drugs are:

Medicines for oral administration

Among the most effective medicines, it is worth highlighting:

In order to know exactly how to cure thrush in a particular case, it is necessary to be guided by the doctor's recommendations in compliance with the prescribed dosages and the duration of the course of treatment. In some cases, it is better to make the treatment complex, with the use of external and oral medications. Some time after the end of the course of taking the medicine, it is necessary to take a smear again in order to ensure the success of the treatment.

When choosing a drug, it should be remembered that most drugs have a number of contraindications. At the same time, Pimafucin and Zalain cause the least harm to the body. They are the best medicines for pregnant and lactating women.

ethnoscience

On the initial stage diseases answer the question "how to get rid of thrush" can ethnoscience. Her fight against the disease is based on the use of herbs and natural antiseptics. to the most effective folk recipes relate:

Despite the fact that traditional medicine offers a lot of treatment options, none of them can be used as an independent remedy for thrush without the participation of medicines.

Most of the fair sex knows about the symptoms of thrush firsthand. I must say that this disease also does not bypass men. Meanwhile, the causative agent of thrush is a resident of our normal microflora. Why he begins to behave aggressively, and what to do about it - will tell the gynecologist Albina Romanova.

How to properly treat thrush?

Thrush(vulvovaginal candidiasis) - a fungal infection that is caused by microscopic yeast-like fungi of the genus Candida (most often Candida albicans), and is characterized by inflammation of the mucous membrane of the vulvar ring, vagina, urethra, perineum as a whole. These fungi are classified as conditionally pathogenic microorganisms (that is, they are part of the normal microflora of the mouth, vagina and colon of almost all healthy people), therefore, for the development this disease it is important not just the presence of fungi of this genus, but their reproduction in very large quantities, and this, most often, occurs with a decrease in immunity.

Doctors call thrush and candidal colpitis, and vulvovaginal mycosis, and urogenital candidiasis, and genital fungus, but the essence of this does not change, this is one and the same pathological process.

Unfortunately, thrush is a very common disease among the female population. More than 75% of women all over the planet have suffered this disease at least once in their lives, and a third of them who have received sufficient therapy fall ill again (there is a relapse of the disease).

Factors contributing to the spread of thrush

• wearing synthetic, tight-fitting underwear (for example, the well-known "thongs") - damage to the mucous membranes in places of friction, the introduction of microflora from the anus into the vagina.
• Use of daily sanitary napkins.
• Unnatural sexual intercourse (anal, oral) - there is a violation of the normal microflora of the vagina, contributing to the development of thrush.
• Diabetes mellitus - strong changes in the immune system, frequent urination, obesity (usually associated with diabetes), difficulties with personal hygiene, ulceration of the mucous membranes of the urinary tract - contribute to the development of thrush.
• Treatment with broad-spectrum antibacterial drugs - kill not only pathogenic microorganisms that caused the disease (for example, pneumonia), but also opportunistic microorganisms inhabiting our gastrointestinal tract and genital tract: in the "empty" place, the fungal flora develops and grows very well - thrush occurs.
• Pregnancy - decreases during pregnancy immune defense, to fertilized egg was not perceived by the body as a foreign body, therefore, expectant mothers are more susceptible to any infections, including candidiasis.
• The use of high-dose oral contraceptives (containing 30 or more micrograms of ethinyl estradiol), intrauterine contraceptives (spiral), spermicides, diaphragms (for contraception) - weakening of the local protective barrier in the vagina.
• The use of glucocorticosteroids is a factor in changing metabolism in organs and tissues, contributing to the development of thrush.

Vulvovaginal candidiasis (thrush) is not a sexually transmitted infection, despite the fact that the same strains of fungi are detected in sexual partners. Most likely, this pathology can be associated with a defect in the immune system at different levels (decrease in general or local immunity). Candidiasis is not a disease, since a healthy person has these opportunistic pathogens.

Thrush is classified into:

1. Acute candidiasis.
2. Recurrent (chronic) candidiasis.

Thrush manifestations:

1. Itching and burning in the vagina and in the vulva, aggravated during sleep, after water procedures, after intercourse, during menstruation.
2. Beli - abundant or moderate cheesy discharge from the genital tract from white to gray-yellow, odorless.
3. Painful intercourse.
4. Painful (with cutting) and frequent urination.
5. Swelling and redness of the mucous membranes of the external genital organs, traces of scratching (maceration of the skin and mucous membranes).

There can be both all of the above signs of thrush, and part of them (the disease is erased, without pronounced complaints from the patient).

What is required for the diagnosis of thrush (candidiasis)?

The patient has complaints of itching, curdled discharge from the genital tract, impaired urination, symptoms of local inflammation in the vulva (edema, redness, maceration), data laboratory research: microscopy of smears from the vagina - detection of yeast-like fungi and pseudohyphae, vaginal pH 4-4.5, aminotest is negative (when alkali is added to vaginal discharge, there will be no smell of stale fish), when the discharge from the vagina is sown on appropriate nutrient media, growth is observed mushrooms (here you can evaluate their species, quantity, sensitivity to one or another antibacterial drug). There are additional (and expensive) methods for confirming the diagnosis of vulvovaginal candidiasis - immunofluorescent diagnostics ("CandidaSure"), compliment binding tests, immunological studies and rapid methods. They are most often based on an antigen-antibody reaction, that is, on a pathogenic microorganism (antigen), our immune system produces protection (antibody): the antibody binds to the antigen, neutralizing the latter. This complex (antigen-antibody) can be identified by these diagnostic methods, or only the antibody is recognized.

Treatment of thrush

It is carried out only under the supervision of a specialist, self-treatment of thrush is fraught with the transition of an acute form of candidal colpitis into a chronic one, with frequent exacerbations and difficult cure.

Stages of treatment for thrush:

1. Fight against predisposing factors(rational antibiotic therapy, maintenance and protection of the immune system, personal hygiene)
2. Diet(carb restriction)
3. Rejection of bad habits.
4. Drug local treatment of thrush (choose one drug):

• Butoconazole, 2% cream 5 g once-topically.
• Ketoconazole, suppositories 400 mg, 1 suppository x 1 time per day for 3 or 5 days.
• Fluconazole 150 mg orally once (Flucostat).
• Itraconazole, by mouth 200 mg x 2 times a day for 3 days or 200 mg (Irunin) x 10 days, tablets that are inserted deep into the vagina.
• Sertaconazole, 300 mg (1 suppository) once.
• Clotrimazole, 100 mg (1 tablet in the vagina) for 7 days.
• Miconazole: vaginal suppositories 100 mg (1 suppository) at night for 7 days.
• Nystatin: vaginal tablets 100,000 IU (1 suppository) daily x 1 time, at bedtime, for 14 days.

1. Drug treatment of chronic thrush:

- a systemic antimycotic (itraconazole 200 mg orally 2 times a day for 3 days or fluconazole 150 mg 1 time per day for 3 days) and

- local therapy with azole drugs (most often within 14 days):

Imidazole preparations:

• ketoconazole (nizoral) - Apply 400 mg / day, for 5 days;
• clotrimazole (kanesten) - Used in the form of vaginal tablets, 200-500 mg for 6 days;
• miconazole - 250 mg, 4 times a day, 10-14 days.
• bifonazole - 1% cream, 1 time per day at night, 2-4 weeks;

Triazole preparations:

• fluconazole - 50-150 mg once a day, from 7 to 14 days;
• itraconazole (orungal) - 200 mg 1 time / day, 7 days.

Despite the high efficiency local treatment thrush in many patients after 1-3 months there is a relapse (exacerbation). This is due to the use of antibiotics, which change the normal microflora of the vagina, concomitant diabetes, taking oral contraceptives, pregnancy (the level of glycogen in the vaginal epithelium is increased - a good breeding ground for fungi), an increase in the number of infected patients with more pathogenic (and more resistant to traditional methods of treatment) species of fungi - C.pseudotropicalis, C.glabrata, C. parapsilosis .

Should the patient's spouse be treated for thrush?

Thrush is not a sexually transmitted disease, and most often it is not necessary to treat a spouse. But there are situations when a man has clinical manifestations(symptoms of itching, irritation and scratching on the penis, white discharge that worsens after sexual contact) with a confirmed diagnosis of candidiasis in a woman. In this case, the treatment regimen for thrush is the same as for a woman. Only treatment is carried out not with local preparations, but for oral administration (Pimafucin, 100 mg x1 tablets 4 times a day for 10 days).

Usually a man does not have symptoms of this disease, even if the woman is sick and undergoing treatment. If symptoms of thrush occur in a man, then his body as a whole should be examined to exclude infections that significantly reduce immune surveillance (such as HIV (AIDS), hepatitis B and C, acute leukemia).

What to do to prevent a recurrence of thrush

In order to prevent a relapse (exacerbation) of the disease, it is necessary to use:

- systemic antimycotic (itraconazole 200 mg orally or fluconazole 150 mg on the first day of menstruation for 6 months, i.e. 6 courses);

- therapy with local preparations 1 time per week for 6 months (drugs that are used in suppositories for vaginal use).

Thrush treatment control

- In the acute form of thrush, treatment is monitored 7 days after the end of treatment (smears and cultures are given for the sensitivity of microflora to antibiotics).

- In chronic candidal colpitis, the evaluation of the effectiveness of treatment is performed within 3 menstrual cycles on the 5-7th day of the cycle (as they stopped bloody issues from the genital tract after menstruation - smears and cultures for sensitivity are taken).

In special cases, for example, treatment of thrush in pregnant women, local antifungal drugs are used, such as: Natamycin 100 mg (pimafucin) 1 suppository at night for 3-6 days (the drug is approved for use in pregnant women even in the first trimester of pregnancy, that is, up to 12 weeks), or clotrimazole 1 vaginal tablet(100 mg) x 1 time per day at night, for 7 days (the drug is approved for use in pregnant women only from 13 weeks of pregnancy).

If the sick patient is a child, then thrush is treated according to the following scheme: fluconazole 2 mg per 1 kilogram of the child's body weight - the entire dose is taken orally once with a small amount of water.

However, describing in detail drugs for the treatment of vaginal candidiasis (thrush), their dosage regimens and courses of treatment, it must be understood that all treatment should be controlled by a doctor. After all clinical picture(symptoms of the disease) typical of thrush are also characteristic of very many pathological processes in the vagina, for example: bacterial vaginosis, atrophic (cyanotic) colpitis, bacterial vaginitis, chronic cervicitis, leukoplakia or vulvar (vaginal) krauses, chlamydial cervicitis, adnexitis, gonorrhea, therefore, the question of treatment should only be in the doctor's office, under careful laboratory and clinical control of the patient's cure.

Be healthy!

Gynecologist Albina Romanova

Dear friends, hello!

Today we will talk about thrush.

Do you often get asked this problem?

I hear your friendly "yes"!

Certainly! Going to the pharmacy is much easier than dragging yourself to the clinic, taking a coupon, waiting in the wings for a week or more ... And no one cares that “there” everything itches, itches and bakes.

And if the advice of a female doctor is “douche with soda and chamomile” or “inject a tampon soaked in kefir” (this is not a fiction), then I want to say a lot of “warm” words to him.

What kind of rubbish is this - thrush? Where does it come from? What do you need to find out from a customer who asks you for something from a thrush? How is this infection finally treated? Why sometimes it doesn't work? What to offer in the complex?

Let's figure it out?

How do mushrooms enter the body?

We have already talked about mushrooms. But it was a conversation about fungal infections and skin.

Among other pathogens of mycoses, I also mentioned yeast-like fungi of the genus Candida.

They are the cause of thrush.

We can acquire them in the process of life, or we can get them as a gift from our mother at birth, if she was visited by a thrush right before the birth.

In the first case, vulvovaginal candidiasis, as thrush is otherwise called, can be infected through direct contact with a sick person, including sexual contact, through a towel shared with him.

In the second case, when passing through the birth canal, the fungi enter the skin of the child, settle on the oral mucosa, penetrate the body with amniotic fluid and become permanent residents of the large intestine, vaginal mucosa.

vaginal residents

However, mushrooms are not permanent and not predominant representatives of the vaginal fauna. Now I wrote this word and thought: I wonder why, when it comes to microbes, they say microflora? After all, "flora" is plants, and "fauna" is animals. Or are microorganisms more like plants?

The main inhabitants of the vagina are lactobacilli. They make up more than 90%.

Bifidobacteria and opportunistic microbes also live here in minimal quantities: gardnerella, mycoplasmas, streptococci, staphylococci, anaerobes, etc.

Lactobacilli perform a very important function: they protect the vagina from external microorganisms, restrain the excessive reproduction of "neighbors" and prevent them from going all out.

The vaginal epithelium is a multilayer construction. Like the stratum corneum of the skin epidermis, young epithelial cells are born in the lowest layer, which divide, mature, moving to the upper layers, and then desquamate.

The epithelial cells of the vagina contain glycogen. Lactobacilli break it down to form lactic acid. This maintains an acidic environment in the vagina at a level of 3.8-4.5, which protects it from pathogenic bacteria.

From this it is clear why douching with a solution of soda, which doctors love to recommend so much, cannot be used. Soda alkalizes the vagina and provokes gynecological problems.

And in general, any douching is harmful, because. wash out beneficial microbes, disrupt the ratio of good and conditionally bad bacteria. There are fewer good ones, but a holy place is never empty, so it is filled by the very conditional pathogenic bacteria who were just waiting for this to start multiplying.

In addition, soda dries the mucous, and dry mucous is vulnerable. Therefore, the reduction of symptoms after such a method of treatment is the calm before the storm. The thrush will play out with renewed vigor, other bad kids will join the mushrooms. Bacterial vaginosis will develop.

What is the first day of the cycle?

You may have seen in the prescriptions of doctors that with recurrent thrush they are prescribed on the first day of menstruation.

Do you know why?

The epithelium of the vagina is hormone-dependent. Estrogens help his cells to accumulate glycogen and, therefore, break it down with the release of lactic acid. They also provide adhesion of lactobacilli to the cells of the vaginal epithelium.

But in the first days of the cycle, estrogen is not enough.

During this period, a large number of destroyed endometrial cells and blood cells enter the vagina, and the environment here shifts to the alkaline side (pH increases to 5.0-6.0).

Therefore, the risk of getting thrush at the beginning menstrual cycle increases.

What causes vulvovaginal candidiasis?

Why is vaginal candidiasis called "thrush"?

Because the discharge in this disease resembles sour milk.

So, the most common factors provoking the appearance of thrush:

1. . They destroy not only harmful, but also beneficial microbes, including those in the vagina, i.e. lactobacilli. There are fewer of them, they cannot perform their protective function, and mushrooms begin to multiply intensively.
2. . During pregnancy, vaginal candidiasis occurs 2-3 times more often.

Sometimes thrush is a marker of pregnancy, when the test still does not show anything, and the fungus is already right there!

This is due, firstly, to a physiological decrease in immunity during this period in order to reduce the activity of the immune system, which regards the fetus as foreign body which needs to be expelled.

Secondly, hormonal changes occur, as a result of which there is too much glycogen in the cells of the vagina, and this is also bad. Lactobacilli do not have time to break it down, and it provokes the reproduction of fungi.

1. Violation of hygiene rules. This is the use of tampons, which, at times, are in an intimate place all day, collecting all the representatives of the vaginal fauna. Here we also include excessive passion antiseptics not intended for intimate hygiene. They, like antibiotics, destroy everyone in a row, without understanding who is right and who is wrong.

Be mindful and tell customers to change tampons every 2 hours!

Some gynecologists oppose not only tampons, but also panty liners, because. they disrupt the access of oxygen to an intimate place.

1. Pools. Chlorinated water dries the mucosa, which leads straight to vaginal dysbacteriosis.
2. Clothing and some toilet articles. These are tight trousers, jeans that squeeze and rub in intimate places, disrupting blood circulation and reducing local protection. The same applies to strings.

About the journey of microorganisms through the thong from point K (intestines) to point B (vagina), we have already been with you once.

We add here underpants made of synthetic materials that trap heat and moisture, which is why mushrooms grow like after rain. So down with lacy sexy lingerie, long live the good old hebeshechki!

1. Often thrush is brought from warm countries. Firstly, climate change is for the body, as a result of which it decreases. Secondly, this means increased humidity in an intimate place if you are in a wet swimsuit all day.
2. Hypothyroidism. As you know, thyroid regulates ovarian function. With its hypofunction, hormonal disorders in the reproductive system are provided. Little estrogen - little glycogen in the epithelium of the vagina. Little glycogen, lactobacilli have nothing to break down. There is nothing to split - lactic acid is not formed in the right amount. Lactic acid is not formed - the acidic environment in the vagina is not maintained.
3. Sweet love. It turns out that mushrooms are a terrible sweet tooth. Therefore, during the treatment of candidiasis, doctors advise to give up sweets and starchy foods. For the same reason, thrush often visits.
4. Combined hormonal. They are on this black list because they create a lower level of estrogen in the female body than natural.
5. estrogen-containing hormonal preparations for HRT. Here is the other extreme: there are a lot of estrogens, the level of glycogen in the cells rises, it pulls water onto itself, the mucous membrane loosens, the pH shifts to the alkaline side. In 20% of women, glucose tolerance changes.
6. Glucocorticosteroids, immunosuppressants - i.e. drugs that reduce immunity.

How does thrush manifest itself?

It is easy to recognize a thrush.

There may be the following complaints:

1. Itching, burning, discomfort in an intimate place, which increase in the evening.
2. White cheesy discharge, odorless. In the people they are called "beli".
3. Pain during sexual contact.
4. Burning when urinating.

Thrush is also found in men, and then white patches, redness, and swelling appear on the genitals. Other complaints are the same as in women, but they are less pronounced.

To confirm the diagnosis of candidiasis, a smear is taken and cultured.

What forms of thrush exist?

There are 2 forms:

1. Acute candidiasis. Lasts no more than 2 months.
2. Chronic candidiasis. Lasts over 2 months.

Chronic candidiasis is divided into 2 types:

• Recurrent - symptoms completely disappear after treatment, but exacerbations occur at least 4 times a year.
• Persistent - symptoms are present to varying degrees constantly. After treatment, they subside somewhat.

What questions should the buyer ask?

When you are asked to give something for thrush, you do not need to immediately offer an antimycotic. Talk to the buyer. What makes her think it's a thrush?

Questions might be:

1. Was this diagnosis given to you by a doctor?
2. How does the disease manifest itself? Itching, burning, pain when urinating? What kind of discharge? (interested in color, texture). White, curdled - this is thrush. If others, then the big question is what is it. Perhaps an STD, and it is pointless to recommend the same Fluconazole.
3. Is this your first time or have you had similar symptoms before? If you already had thrush, find out how often exacerbations occur.

The treatment regimen with Fluconazole depends on the severity of symptoms, the frequency of exacerbations.

Now one of you is reading these lines and thinking:

- Yeah, the line is half a pharmacy, and I'll be interested in secretions?

In order not to embarrass the customer and not to be embarrassed yourself, it is better to go to her in the hall with the words: “Now I will go out to you, I need to clarify something”, then, taking her aside, ask her these questions, because without this your recommendations may not be entirely literate.

General scheme for the treatment of thrush

The treatment regimen depends on several factors:

1. Acute or chronic process?
2. Is it just milkmaid? Often fungi are combined with other representatives of conditionally pathogenic flora, so the task becomes more complicated.
3. How severe are the symptoms?
4. Are there comorbidities?

Comprehensive treatment of thrush includes:

1. Systemic antimycotic.
2. Local antimycotic.
3. After the course of treatment - a vaginal eubiotic to restore the flora of the vagina.
4. With chronic thrush -.

For systemic therapy, fluconazole and itraconazole are most commonly used.

The scheme of treatment of thrush with fluconazole

There are different treatment regimens with Fluconazole, but the following seems to me the most logical:

1. Light discharge, slight itching and discomfort, or new-onset thrush:

Fluconazole 150 mg once for both men and women.

1. Itching, burning, discomfort, copious discharge, 1-4 episodes of thrush per year:

Female: Fluconazole 150 mg twice with an interval of 72 hours.

The male: 150 mg once.

1. Recurrent thrush (more than 4 episodes per year):

Female: 150 mg three times with an interval of 72 hours. Then 150 mg once a week for 6 months.

The male: 150 mg once.

If Fluconazole is ineffective, see a doctor!

If the diagnosis of candidiasis is confirmed, the doctor may prescribe, for example, Itraconazole 200 mg 2 times 1 day or 200 mg 1 time per day for 3 days.

Other

We influence mushrooms in their habitat

For local treatment If, according to the symptoms, this is definitely a thrush, in my opinion, it should be a monodrug: Pimafucin, Livarol, Zalain, Clotrimazole, Ginezol 7, Ginofort.

For a woman, most often these are suppositories or vaginal capsules / tablets, for a man - a cream.

The duration of treatment for each drug is different.

The average duration of the cream in a man is 7-10 days.

As for the combined remedies (Terzhinan, Polygynax, Klion D, etc.), then using them for thrush is like cutting your finger and smearing it with iodine at the same time. With an antifungal component, we will destroy the fungus, and with others - beneficial microbes, while reducing local immunity, which in itself is the cause of thrush.

They are usually prescribed for a combined fungal-bacterial infection.

You ask: but how do you know it?

Firstly, bacterial infection manifested by "colored" secretions (yellowish-greenish).

Secondly, unpleasant smell.

Thirdly, it can give in the stomach, worsening general well-being.

And then, most likely, Macmirror, Flagyl or a broad-spectrum antibiotic is needed inside. Plus combined local remedy such as Terzhinan or Polygynax.

We restore the microflora

Information for thought. In the instructions for such drugs, candidiasis is on the list of contraindications, but doctors prescribe them in the complex treatment of thrush. How to understand it?

I have not found a clear explanation for this. Moreover, opinions on the account of which environment Candida fungi reproduce best are divided: some say that it is in an acidic environment (with which I disagree), others - in an alkaline one. If we assume that they love an acidic environment, then how to explain their existence in the large intestine, where the environment is slightly alkaline?

And yet: why are these drugs contraindicated in candidiasis?

I believe that firstly, because of the excipients. For example, the Acylact preparation says that bacteria are cultivated with the addition of a sucrose-milk medium, and mushrooms, as you now know, love sweets.

Secondly, against the background of candidiasis, the affected cells of the vaginal epithelium contain little glycogen, so lactobacilli will not have enough nutrient substrate, and candidiasis will only worsen.

But after the end of antifungal therapy with negative smears for the fungus, these drugs will be very helpful.

And what do you think about this?

Dealing with immunity

With recurrent candidiasis, the doctor may prescribe Viferon, Genferon, Polyoxidonium in suppositories, and so on.

We care correctly

And ideally, especially with recurrent thrush, it is good to use a special intimate care product that will maintain an optimal environment in the vagina (for example, Lactacid).

For the duration of treatment:

1. Use only cotton linen.
2. Discard thongs and tight pants, jeans.
3. Eliminate sweet, starchy foods from your diet.
4. From sexual intercourse for this period you need to refrain.
5. Both need to be treated.

Why is the treatment of thrush often ineffective?

I found 5 reasons for this:

By the way, if a woman has doubts that this is a thrush, you can offer her FrauTest Candida.

What can be done with thrush during pregnancy?

Pimafucin: suppositories, tablets. The rest is all with some reservations.

That's all I wanted to tell you today.

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With love to you, Marina Kuznetsova