Vaginal discomfort

[Miss1981]

Hi,

I suffered from genital warts a few years ago, but returned to the GUM clinic and was given the all clear after treatment. However, since then I have had frequest episodes of irritation and soreness, and unusual discharge in my vagina. I have been tested for thrush but the result has always been negative. However, my doctor has said to use canestan to treat these episodes. I find my symptoms worse about a week after my period. I experience itchiness, pain when having sex, and have recently started to experience some abdominal pain also. My doctor has said it is cylical thrush, and won't even examine me anymore. I use the canestan cream, but still suffer. From my own examination, I cannot see any warts, but there can be a yellow crusty discharge on my inner lips at times. I never feel clean, and can smell a yeast type odour all the time. Should I go back to the GUM clinic, or try a gynaecologist instead as I am having no luck with my doctor?

[Mr Peter Greenhouse]

Hi - cyclically recurrent thrush occurs because a woman's immune system is lowest in the few days before each period. It's the same mechanism which causes acne, urticaria, cold sores etc to get worse or recurr at this time. The best way to deal with it is to work out the timing of onset of symptoms within your cycle - if it is predictable (as it should be in the majority of cases, and take a tablet of Fluconazole 150mg a couple of days before this date. An alternative is the so-called Detroit regime described by the world expert on recurrent candidiasis (Dr Jack Sobel) - this involves taking three x 150mg Fluconazole three days apart from each other. This usually wipes out most recurrent thrush for around 3-4 months.
You should return to the Sexual Health clinic when you next have symptoms (or book an appointment to coincide with the few days before your period) and make sure they send off a swab for formal mycology testing of the antifungal treatment susceptibilities of the particular strain of Candida you have.
Another strategy, if you have obvious premenstrual recurrences, would be to consider a method of contraception which stops you having cycles, such as the Depoprovera injection of the Mirena hormone coil.
Whatever you do, just taking Canesten cream for recurrent thrush is no solution at all. Get better advice from the specialists at the clinic.