Recurrent thrush in women occurs often because fungi of the genus Candida, which inhabit the vagina, are opportunistic flora and are activated under favorable conditions.

The key to successful treatment

Meanwhile, treatment of recurrent thrush does not present any difficulties if you adhere to the following rules:

• do not neglect examination by a gynecologist and do not refuse to take a smear test;
• do not prescribe medications yourself;
• do not interrupt the course of treatment when the main symptoms disappear;
• do not use folk remedies who don't have therapeutic effect in the treatment of this disease.

And do not save on medications by choosing cheap analogues yourself. If you explain your situation to the doctor, he will write out a diagram of how to successfully treat recurrent thrush using cheaper means.

Information about the disease

The causes of recurrent thrush may include the following factors:

• infectious diseases, lowering the body's immunity;
• chronic infections, especially those affecting reproductive organs and genitourinary system;
• infection with sexually transmitted infections;
• chronic diseases of all body systems;
• hormonal or endocrine changes and disorders – diabetes mellitus, thyrotoxicosis, obesity, pregnancy;
• intestinal dysbiosis;
• long-term use of hormonal contraceptives or hormonal drugs;
• taking antibiotics.

Recurrent thrush may worsen when improper treatment, unsystematic use of medicinal products.

Thrush occurs not only in women, but also in men, but the disease persists for a long time only in special conditions– with a significant decrease in immunity, for example, in patients with AIDS.

The male genital organs are designed in such a way that during urination, candida is washed out. However, it is necessary to treat men and women who are sexual partners together, since, albeit in small quantities, the opportunistic culture is present in men.

The main symptoms of the disease are the following:

• curdled discharge;
• hyperemia of the mucous membrane;
• the occurrence of itching and burning;
• pain and stinging when urinating.

As the disease worsens, the mucous membrane of the vulva becomes covered with a continuous coating, which is difficult to remove - pinpoint bleeding appears on the mucous membrane.

Diagnosis and treatment of thrush

Diagnosing the disease in its acute form is quite simple. It is enough to take a routine smear test during a gynecological examination.

For chronic thrush, a treatment regimen is developed only when the degree of infection is determined - using special blood tests. The body has already developed antibodies to candida, it rarely manifests itself, it is activated concomitant diseases. Therefore, it is quite difficult to independently solve the problem of how to cure recurrent thrush.

After the reasons why the thrush worsened are determined, complex therapy. It includes drugs for stabilization general condition and medications that directly stop the activity of candida.

To cure the disease, inpatient treatment not required. You can deal with it at home.

The treatment regimen for recurrent thrush necessarily includes local and general action.

Be sure to do it first bacteriological culture, during which the degree of damage to the body is revealed.

Antifungal drugs have to be used for several months. Modern means cause a minimal amount side effects.

The main components of the majority modern drugs is fluconazole. Such drugs include “Diflucan”, “Flucostat”, “Fluconazole”.

People try not to prescribe medications with nystatin - with chronic candidiasis, the body has time to adapt to them.

If the question arises of how to treat recurrent thrush with breastfeeding, then use “Pimafucin”. This product is absolutely safe and is not absorbed into breast milk. It can also be used during pregnancy.

Used together with oral medications local action. These include dosage forms: suppositories, vaginal tablets, candles.

The most popular among them are the following drugs:

• "Terzhinan" - vaginal tablets that are soaked before use. Effectively stops the activity of candida, treat the mucous membrane with care. Contains the hormone prednisolone;
• “Clotrimazole” - available in the form of ointments and suppositories, quickly eliminates unpleasant symptoms;
• During breastfeeding and pregnancy, Livarol is prescribed from the second trimester. Produced in tablets, the main active substance– ketoconazole;
• The appointment of Hexicon is considered advisable. This very strong antiseptic not only destroys candida, but also effectively resists other pathogenic flora that cause various sexually transmitted infections. The product contains chlorhexidine bigluconate and polyethylene coside.

The second stage of treatment involves the use of drugs that increase general and local immunity. These include probiotics. They are also consumed topically and orally.

Without eliminating dysbiosis, thrush cannot be cured. The most commonly used are “Bifiform”, “Linex”, “Lactofil”, “Probiform”. The vaginal microflora is restored by dosage forms produced in the form of suppositories: “Laktovag”, “Bifolact”, “Lactonorm”, “Gynoflor”, “Acilact”.

Local medications have virtually no contraindications, and a reaction to them can only occur due to individual intolerance.

At the same time, you will have to follow a diet - you will have to exclude foods that cause candida activity from your diet. These include: yeast baking, grapes, beer, carbonated drinks, sweets, spicy seasonings.

A regular sexual partner should also be treated. He will have to take a course of antifungal medications and use topical agents, even if he does not have any symptoms indicating infection. As noted above, in men symptoms rarely appear - only when the body is weakened.

During treatment, it is necessary to strengthen individual hygiene measures, change underwear more often and bedding. Refuse the desire to show off elegant lace panties - intimate lingerie should be made from natural fabrics, preferably cotton.

You will also have to do without intimate specific means– gels and detergents with fragrances, special perfumes, scented pads.

For washing intimate area you will have to use special products that help normalize the vaginal microflora, for example, “Lactocide”.

Mistakes in the treatment of candidiasis

In most cases, the culprits that the disease has become chronic are the patients themselves.

Thrush, or candidiasis, is a disease caused by fungi of the genus Candida. The development of the disease in women is associated with a number of different external and internal factors (hormonal imbalance, irrational antibacterial therapy, failure to comply with hygiene rules).

The symptoms of vaginal candidiasis are familiar to many - itching in the external genital area and a curd-like discharge white. Despite the fact that there are effective drugs and diet for therapy, it is not always possible to completely cure the disease.

If thrush returns more than four times a year, then a diagnosis of “chronic candidiasis” is made.

Why recurrent thrush appears and what consequences this may have are questions that concern many women.

Causes of development and manifestation of chronic candidiasis

Why do long-lived candidiasis infections appear? Chronic thrush, according to recent studies, appears in women due to the heterogeneity of the fungal population of the genus Candida.

Previously it was believed that candidiasis is caused by the fungus Candida albicans, but now given point view has been refuted, and several different fungi of the same genus are involved in the occurrence of fungal infections.

In this regard, the antifungal drugs and diet used may not be effective against certain microorganisms.

For example, imidazole derivatives (Clotrimazole, etc.) cope well with the above type of fungus, but other representatives of the genus Candida are characterized by reduced sensitivity to this drug and can persist in the body for a long time, causing chronic candidiasis.

Other factors that increase the risk of chronic infection:

Due to these reasons, it is difficult to definitively cure chronic candidiasis, which leads to the formation of a chronic focus of fungal infection. Moreover, in order to get rid of this condition, long-term and complex treatment will be required.

Due to the fact that examinations for the activity of the immune system do not find any abnormalities, there is a point of view that chronic thrush is not an immunodeficiency state, but, on the contrary, its excessive activation. This complements the reasons for the development of the disease.

Important! Consequences long term candidiasis pose a great threat to a woman’s fertile function, regardless of the cause of its occurrence.

A significant number of women in the population have a constant presence of fungal microflora in the vagina. However, they do not have symptoms of the disease. It is important to note that chronic thrush is not characterized by constantly presenting symptoms of the disease. As a rule, women with this diagnosis observe the following manifestations:

A number of women, in addition to the indicated signs, note the appearance of sexual partner a feeling of itching and a rash on the penis after sexual intercourse and other symptoms of thrush in men.

Principles of therapy

Treatment chronic thrush– a difficult and complex task, including preventing negative consequences for women's fertile health. The optimal regimen and diet to cure the chronic form of candidiasis has not yet been identified. However, there is a list of recommendations that will help get rid of this disease.

Persistent thrush requires initiation of therapy with an antifungal drug, regardless of its form: capsule, tablet, vaginal gel, or a special ring inserted into the vagina.

Based on the fact that treatment of chronic candidiasis is a long process, most women prefer drugs taken orally. On average, the duration of therapy is from three to six months, and it is necessary to undergo repeated therapy every month. medical consultation. The latter is necessary for constant change dose and searching for its optimal value.

In approximately half of the cases, against the background similar treatment chronic thrush goes away and no longer bothers the woman, however, the other half is less lucky - they need to constantly monitor their health and use antifungal agents (tablets, gels or suppositories), as well as follow non-drug recommendations, such as a certain diet and lifestyle.

Exactly like this integrated approach and will completely cure candidiasis.

In case of taking oral combined contraceptives, you should consult your doctor about continuing their use. If a woman has an intrauterine device and thrush appears after its installation, then it is better to get rid of it.

The most effective drugs for the treatment of candidiasis in women are antifungal suppositories and vaginal gels that have a local effect on fungal microflora.

Medicines for thrush

Recurrent thrush is a serious disease for effective treatment which takes more than one month. The following drugs are used to treat the disease in women.

Fluconazole-based drugs

There are Flucostat and Diflucan.

Flucostat is the most commonly used antifungal drug in Russia. Its main active ingredient is fluconazole, which allows you to get rid of fungal microorganisms.

In pharmacies it is presented in the form of capsules with different dosages– 50 or 150 mg. It can be used for various candidiasis, including thrush.

However, there are also important contraindications:

• various cardiac arrhythmias;
• frequent drinking of alcohol;
• acute diseases of the urinary system and kidneys.

It is necessary to treat thrush with Flucostat as follows: a capsule of the drug is taken three times - on the first, fourth and seventh day.

In some cases, it may be necessary to take the drug for several months (four times a month, i.e. every week). This will remove symptoms and prevent recurrence of the disease.

Sometimes side effects may occur: nausea, dizziness or allergic reactions.

Diflucan is another representative medicines based on fluconazole. Has large number dosage forms– Available in the form of capsules with various dosages, powders and solutions. The regimen for treating thrush with Diflucan is no different from Flucostat, however, you should consult your doctor.

Pimafucin and Clotrimazole

The main feature of Pimafucin is the possibility of use during pregnancy and breastfeeding. It has several dosage forms - suppositories, tablets and vaginal cream.

Candles are the most effective form, which allows you to get rid of the recurrent course of the disease and remove all symptoms. The suppositories must be administered intravaginally once a day for 7-8 days.

If necessary, on the recommendation of the attending physician, the course of treatment can be repeated every month. Side effects applications this tool are minimal and include mainly local allergic reactions at hypersensitivity body to the components of the drug.

Clotrimazole is another active antifungal agent. The main forms of release are candles, cream and a special aerosol for spraying. Indications, treatment regimen and possible side effects are similar to Pimafucin.

Livarol

The active ingredient is ketoconazole, which effectively destroys Candida fungi and relieves the symptoms of candidiasis. Suppositories are most often used for treatment. Their repeated use is possible every month if there are risk factors for the recurrence of the disease on the recommendation of a gynecologist.

Hexicon

Under its name, it combines drugs with an antiseptic effect that have a fungicidal effect. The main form used is suppositories, which allow you to treat fungal infection locally, without systemic effects on the body.

Symptoms under the influence of Hexicon disappear after a few days. It is possible to re-use the drug every month if the woman has risk factors for recurrent thrush. Hexicon suppositories have a minimal risk of side effects.

The consequences of long-term, recurrent thrush are very serious, so it must be treated when the first symptoms appear. The reasons that cause the re-growth of fungal microorganisms are stated above, therefore the entire range of therapeutic measures should be aimed at eliminating them, including the need for a special diet.

The disease candidiasis or thrush is quite common nowadays, and relapses occur even more often. It would seem that today there is a huge amount of means for treatment and prevention fungal disease, however everything more people When they visit a specialist, they hear that they have recurrent candidiasis (recurrent thrush).

There are many causes of thrush, as well as reasons for relapses. Thrush develops in people with weakened immunity, chronic forms of various diseases of the respiratory and digestive organs, when treating only one partner, in the presence of hidden infectious diseases and problems caused by diseases of the genitourinary system.

Causes of relapses

• chronic form of the disease;
• the presence of diseases that contribute to relapse (HIV, tuberculosis, diseases of the digestive tract and others);
• promiscuity;
• allergies and special susceptibility of the body to candida fungus;
• diabetes mellitus, hormonal imbalance;
• long-term use of antibiotics;
• frequent colds and viral infections;
• various types of herpes;
• chronic diseases of the pancreas, gall bladder and intestines;
• hidden infections of the genitourinary system;
• interrupted treatment or self-medication.

Recurrent thrush

The chronic form of thrush is more common than you might imagine. There are a lot of reasons and the first of them is interruption primary treatment When the symptoms of the disease disappear, it seems to the person that he is already healthy. However, the fungus continues to spread in the body. Incomplete treatment results in a chronic form of the disease, which is not always easy to recognize the first time.

A person continues to be a carrier of candidiasis, while infecting others.

The chronic form, especially the hidden one, is much more difficult to recognize, and treating such thrush requires a long and complex process.

Advanced diseases that a person suffers from can provoke the occurrence of thrush, even if the treatment has been completed completely. Chronic forms weaken the body, immunity gradually decreases, which means it becomes more and more difficult to deal with many problems. Lack of immunity contributes rapid growth pathogenic bacteria, microbes and fungi, which include candida.

Infections present in genitourinary system, are another important factor occurrence of relapses of thrush. It is necessary to identify the cause, otherwise the return of the disease is inevitable. Such diseases include herpes, which is very difficult to diagnose, sometimes it remains in a “dormant” state for years, and is even more difficult to treat, but it is this that contributes to the occurrence of relapses in candidiasis.

It is very important to pay attention to nutrition. Excess weight can cause both the disease itself and lead to chronic form. Eating a lot of sweets in general poor nutrition, leads to dysbacteriosis, which means that fungi can begin to actively multiply in an environment favorable to them. In this case, it is necessary to treat the underlying disease and only in the future does it become possible to get rid of chronic candidiasis.

Don't forget about hormonal disorders and disruptions that occur during pregnancy or problems with the thyroid gland, when the body is rebuilt and loses its protective properties.

The recurrent form of candidiasis recurs at least four times a year, even with long-term treatment, if it is not completed. There are cases when the disease occurs within a week after the next treatment. This form occurs in people with very weak immunity constantly suffering from colds, suffering chronic runny nose, bronchitis. Immunity can be significantly reduced in cases where a person works without vacation, sleeps very little, or is under constant stress or depression. All these factors contribute to the development of both chronic diseases and relapses of the fungal disease candidiasis.

How to treat a relapse

First of all, you need to remember that you cannot self-medicate under any circumstances. When contacting a specialist, you must go through full examination in stock hidden infections And chronic diseases. As a result of the examination, the doctor will be able to prescribe a course of therapy and suggest a treatment regimen.

• repeated candidiasis is treated over a long period of time and comprehensively;
• The basis of treatment is antifungal drugs;
• taking medications is carried out under the supervision of a doctor;
• Treatment of both sexual partners is necessary.

The expected course of therapy may look like this:

1. Medicines (tablets) and vaginal suppositories for a long time, up to three months.
2. Examination by an endocrinologist, if available overweight, taking hormonal medications, if you have diabetes.
3. Drawing up a nutrition plan, including live yoghurts, natural juices, and products with a pronounced antifungal effect. These include garlic, ginger, grapefruit, lingonberries, cranberries, and hot peppers.
4. Examination by a urologist to detect diseases of the kidneys and bladder.
5. Examination by a gynecologist for the presence of hidden infections and their further treatment.
6. Testing once a week and adjusting the course of therapy to treat thrush.

In case of repeated relapse, the treatment regimen is repeated, but other drugs can be used, which are selected individually. The duration of the appointment is determined by the doctor. Self-medication is unacceptable, as it leads to repeated recurrence of the disease and the need to consult a specialist.

Relapse Prevention

• treatment of chronic diseases;
• restoration of immunity;
• proper nutrition and rest;
• healthy lifestyle, refusal bad habits(alcohol, smoking);
• visiting a gynecologist at least twice a year;
• absence of promiscuity;
• compliance with personal hygiene rules.

Thrush, as well as its relapses, are curable with the right approach to the treatment itself and to the prevention of candidiasis. The sooner therapy is started, the greater the chance that the disease will not return.

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Today, there are a large number of medications for the treatment of thrush. Therefore, it is not surprising that when you go to a pharmacy, it is difficult to choose the necessary medicine. For those who want to better understand this abundance and make an informed choice suitable drug, the following information will be useful.

The main question is: in what cases is it better to take pills, and in what cases to use creams and suppositories? After all, are these methods of application different in some way?

Medicines for the treatment of thrush, depending on the method of application, are divided into 2 groups - local and systemic:

1. Local - vaginal cream, tablets or suppositories.
   Advantages: safer, do not create resistance to them in fungi, create a high concentration of the substance with minimal systemic action, and allow you to avoid unwanted side effects. Many of them can be used during pregnancy.
   Flaws: if the focus of a fungal infection is located, for example, in the intestines, local remedies will be ineffective.
   Medicines for local application(cream, tablets or suppositories) are injected deep into the vagina 1 - 2 times a day, morning and evening before bedtime. Treatment is carried out until recovery, on average 5-7 days, but with chronic thrush it may take more long time. Intravaginal forms of drugs are not used during menstruation.
   Local treatment is most often quite sufficient for new-onset thrush and its mild course.
2. Systemic - tablets or capsules taken orally, which are absorbed from the intestines into the blood and penetrate into all organs, tissues and cells of the body.
   Advantages: allow you to influence other foci of infection (for example, the intestines), as well as fungi that live in the thickness of the walls of the vagina, and not just on its surface.
   Flaws: possess a large number side effects and toxicity, including hepatotoxicity. Therefore, their use during pregnancy is contraindicated. The exception is the non-toxic but ineffective pimafucin.
   Systemic drugs are used if adequate local treatment or with frequent relapses of thrush (more than 4 times a year).

According to the mechanism of action on fungi, antifungal agents are:

1. Preparations with fungicidal action– those that directly damage mushrooms and cause their death. More often these are products for topical use, because... when using them, it creates a very high concentration drug sufficient to cause direct damage and death of the fungus.
2. Preparations with fungistatic action- those that suppress the proliferation of fungi, disrupting the synthesis of individual components necessary for the construction of its cell membrane. In this case, new mushrooms cannot form, but existing ones do not die. Once the fungistatic agent is removed, growth resumes. This mechanism of action is typical for systemic therapy drugs.

However, the most appropriate is the use of drugs that have both a fungistatic and fungicidal effect.

Local antifungal agents for the treatment of thrush (5 groups).
(Given first international titles, and in brackets – commercial).

1. The largest and most frequently used group antifungal drugs- "azoles".
They block the synthesis of ergosterol, the main component of the cell wall of fungi. Without ergosterol, the integrity of the cell membrane is disrupted, the intracellular components of the fungus enter the extracellular space and the fungi die. Fortunately, ergosterol is not a component of the human cell membrane and “azoles” do not harm them.

• Clotrimazole (Amiclon, Candide B6 Antifungol, Candibene, Kanesten, Kanison, Clotrimazole).
• Ketoconazole (Livarol, Lotseril).
• Fenticonazole (Lomexin).
• Isoconazole (Gyno-travogen Ovulum).
• Miconazole (Ginezol 7, Gyno-daktarin).
• Butoconazole (Gynofort)

All these agents have the same mechanism of action and have approximately equal efficiency, which depends on the sensitivity of the fungal flora to a particular drug.

2. Polyene antibiotics. They are used much less frequently, because less effective.

• Natamycin (Pimafucin, Primafungin)

3. Povidone-Iodine (Betadine, Iodoxide, Vocadine) - iodine compounds, contraindicated in case of dysfunction thyroid gland and during pregnancy, because may interfere with the formation of the thyroid gland in the fetus.

4. Combination drugs, including antibiotics and hormones.

• Klion-D 100 (miconazole + metronidazole)
• Polygynax (Neomycin + Polymyxin B sulfate + Nystatin)
• Terzhinan (neomycin + nystatin + prednisolone)

The use of combination drugs, including broad-spectrum antibiotics and hormones, for thrush is inappropriate, since they suppress the normal microflora of the vagina.

5. 5-10% solution of borax in glycerin. Currently, it is practically not used, because This is an ineffective method of treating thrush.

Antifungal drugs for systemic use for thrush (3 groups).

1. Group of “azoles” with systemic action.

• Fluconazole (Diflucan, Diflazon, Ciscan, Flucostat, Medoflucon, Forkan, Mikosist, Fluconazole).
  For a fresh episode of thrush, it is enough to take fluconazole at a dose of 150 mg twice with an interval of 3 days. For frequently exacerbating thrush, after this double dose, 150 mg is prescribed once a week for 6 months. There is also a treatment regimen in which fluconazole is taken 150 mg every three days for 2 weeks. Fluconazole has high bioavailability and effectiveness, it penetrates into all tissues of the body, has low toxicity and the frequency of side effects. The downside is that C. albicans may develop resistance to fluconazole over time. If treatment with fluconazole does not respond, candidiasis caused by naturally resistant candida species should be considered. In such cases it is recommended antifungal therapy effective but potentially toxic amphotericin B.
• Ketoconazole (Nizoral). The average dose is 200 mg 2 times a day or 400 mg 1 time a day with meals. The average course of treatment is 7 days. Ketoconazole in the form of tablets has a predominantly fungistatic effect, but when applied topically in the form of creams and suppositories, its high concentration (1-2%) is created, which is sufficient to develop a fungicidal effect.
• Itraconazole For thrush, take 0.2 g 2 times a day for 1 day or 0.2 g 1 time a day for 3 days. For chronic recurrent fungal vulvovaginitis - 0.2 g 2 times a day for 7 days, and then for 3–6 menstrual cycles 0.2 g on the first day of the cycle.

2. Polyene antibiotics

• Natamycin (Pimafucin, Primafungin). Efficiency is low.
• Nystatin. Currently not applicable, because is ineffective.
• Amphotericin B. Effective drug, however, it is used only for serious systemic fungal infections, because is extremely toxic. It is not intended to treat fungal infections such as thrush. The only exceptions are cases of persistent, severe candidiasis that is not treatable with other means, including fluconazole. But in these cases, treatment is carried out in a hospital.

Important! In all cases, when without system tools these 2 groups cannot be avoided; mandatory use of hepatoprotectors is necessary - drugs that protect the liver from toxic effects.

3. Caprylic acid (Candida Clear). Represents fatty acid, which is found in coconut and palm oils. Caprylic acid prevents the growth of yeast fungi, and, above all, the genus Candida, and also maintains the normal balance of microorganisms in the intestines. This remedy does not have a toxic effect and therefore can be used without hepatoprotectors.

General treatment regimen for thrush in women, depending on the course of the disease.

I. First-time thrush and mild course.
Most often, when thrush occurs for the first time and has a mild course, the use of topical medications is sufficient. These could be suppositories, creams or tablets with clotrimazole, ketoconazole, fenticonazole, or others. For example:
— Lomexin (600 mg capsules) – one capsule intravaginally, repeat after 3 days.
— Or Livarol ( vaginal suppositories 400 mg) - 1 suppository per day for 5 days.
- Or Pimafucin - 1 vaginal suppository for 5-6 days.
During menstruation, local treatment is not used.
In addition, for mild thrush, instead of topical medications, a single dose of fluconazole at a dosage of 150 mg orally is possible. Occasionally there is a need to repeat the dose after 3 days. However, we must remember the toxicity of fluconazole.

II. Chronic or recurrent thrush (more than 4 exacerbations per year). In these cases, combination therapy of systemic and local antimycotic agents is required.
Local remedies (suppositories, creams or tablets) with clotrimazole, ketoconazole, fenticonazole or others are prescribed 2 times a day for at least 2 weeks, followed by maintenance therapy.
Used simultaneously with local agents systemic drugs Fluconazole - 150 mg orally on days 1, 4, 7, or for 10 days, then 1 capsule per week for 6 months.
For example:
Livarol (vaginal suppositories 400 mg) is prescribed 1 suppository (400 mg) 2 times a day for 10 days and then 1 suppository per day 5 days before each menstruation for 6 months. At the same time, Fluconazole (150 mg) is prescribed according to the above regimen.

Treatment of candidiasis (thrush) in men

As in women, when treating candidiasis in men, it is important not only to get rid of the fungus, but also to eliminate factors predisposing it, for example, an abundance of sweets in food.
For candidal balanoposthitis (damage to the glans penis and foreskin), local treatment is sufficient. Apply cream with clotrimazole, ketoconazole or fenticonazole. It is applied thin layer on the head of the penis and foreskin 2 times a day for 8-10 days.
A single dose of fluconazole 150 mg is also possible.

Treatment of thrush in sexual partners

By modern ideas, treatment of a sexual partner in the absence of symptoms of the disease is not necessary, but is desirable.
However, if a woman has a chronic recurrent process, it is necessary to examine her partner. If fungi are detected, treatment should be carried out regardless of the clinical condition.

When treating a couple, the following treatment regimen is usually prescribed:
Fluconazole (150 mg) for both partners: a single dose is enough for a man, repeat the dose after 3 days for a woman.
It is also necessary to simultaneously use local remedies. Suppositories with Ketoconazole - for women. For a man - cream with Ketoconazole on the head of the penis. The duration of treatment depends on the form of the disease - acute or chronic.
During treatment, it is better to abstain from sexual activity.

What you should pay attention to before starting treatment.

Before you start treating thrush with antifungal drugs, it should be borne in mind that many of them, especially systemic ones, have a number of side effects and are extremely toxic to the liver and kidneys. Moreover, the use of systemic antifungal agents is sometimes contraindicated or unjustified, so it is necessary to compare the risk from thrush and the risk from taking these drugs.

In any case, before immediately resorting to taking systemic antifungal drugs, it is advisable to:

1. Consider whether you have taken antibiotics in the near future, hormonal drugs, including contraceptives, or immunosuppressants, which could interfere with the composition normal microflora vagina or lead to decreased immunity.
2. Pay attention to your diet. Does it contain too many carbohydrates - sugar, buns and cakes, which create favorable environment for mushroom growth?
3. Do you often douche? After all, this removes beneficial microflora.
4. Take a blood test for sugar, because... Thrush can often be the first sign of developing diabetes, and changing your diet can have positive results.
   All of the above factors can provoke the development of the disease, and if they are not eliminated, the use of even the most strong means may be ineffective.

All medications must be prescribed by the attending physician, taking into account individual indications, contraindications, allergies, liver and kidney conditions, etc.

Common infectious pathology women's genitals reproductive age. Up to 75% of women have experienced this at least once in their lives unpleasant illness, and in 40% recurrent thrush accompanies it throughout life.

Etiology and pathogenesis

Thrush is caused by yeast-like fungi of the genus Candida albicans, which contains more than 200 species of both harmless and pathogenic strains.

Normal vaginal microflora healthy woman 95-98% consists of lactobacilli with a small content of opportunistic microorganisms (bifidobacteria, enterobacter, fungi and others). Lactobacilli, breaking down the protein glycogen, produce lactic acid, which maintains pH vaginal secretion at the level of 3.8 – 4.2. Such acidic environment not to the taste of many pathogenic microorganisms.

Candida fungi belong to the opportunistic flora and are present in small quantities on skin, mucous membranes oral cavity, in the intestines, in the contents of vaginal secretions. At high level They do not cause harm to both general and local immunity and are in an inactive state.

But it is enough for the body to weaken under the influence of various unfavorable factors the number of lactobacilli is reduced, the environment in the vagina becomes alkaline, dysbiosis develops, and the vaginal mucosa begins to actively colonize fungal colonies.

Women's high susceptibility to fungal infection genitalia is associated with the anatomical and physiological characteristics of her body: the external genitalia, covered with a moist mucous membrane, are the optimal place for the proliferation of fungi. Besides, female body subject to frequent fluctuations in hormonal and biochemical processes associated with menstruation and pregnancy.

Recurrent thrush occurs against the background of vaginal dysbiosis.

Causes of vaginal dysbiosis:

• Hormonal disorders: with endocrine diseases, before menstruation, during pregnancy, after abortions and miscarriages, childbirth, as well as during puberty and menopause.
• Inflammatory and infectious diseases of the pelvic organs.
• Venereal diseases.
• Long-term use of antibiotics, corticosteroids, cytostatics.
• Sudden climate change: hypothermia, overheating, excessive exposure to the sun, when immune system does not have time to adapt to new conditions.
• Ignoring the rules of personal hygiene of the genitals.
• Irrational use of pads and intravaginal tampons (allergy to the material, infrequent replacement, microtrauma of the vaginal mucosa).
• Reception oral contraceptives and the use of other means of preventing pregnancy ( intrauterine devices, spermicide ointments).

The microecology of the vagina is disrupted, the growth of fungal colonies increases, which, multiplying, occupy more and more territories of the urogenital zone. Signs soon appear acute thrush: curdled discharge, itching, pain during urination and sexual relations.

The diagnosis of chronic recurrent candidiasis is made when a woman has four episodes acute form thrush for one year.

Symptoms and causes

The development of recurrent disease is explained by disruption of the functioning of cellular and humoral immunity. There is insufficient production of immunoglobulins and a decrease in the activity of phagocytes. Medicines during this period only suppress the number of fungal colonies, but cannot completely cope with the pathogen. The return of symptoms of the disease occurs either immediately after treatment or several months later.

Signs of chronic thrush:

• Redness and swelling of the vaginal mucosa.
• Feeling of burning, dryness and itching in the genital area.
• Dense white coating, difficult to separate from the vaginal wall.
• After removing the film, eroded surfaces remain.
• The discharge, in contrast to the acute form, is insignificant, glassy, ​​and stretchy.
• There is no pain during sex, but episodes of discomfort are possible.

Fungi penetrate deeply into the vaginal mucosa with their processes - pseudomycelia, causing inflammation and atrophy of the surface layer of the endothelium. In the case of massive colonization of fungi in the genitals, hypersensitivity to them is formed, which leads to the development severe complications. There is no clear answer to the question why does thrush recur?

The reasons for the transition from acute to chronic candidiasis are multifactorial. They are related to the state of the body: if present endocrine disorders(diabetes), hormonal imbalances, inflammatory diseases pelvic organs, then the course of thrush will be long and persistent.

Treatment

Before this, a diagnosis is carried out, including microscopy of a vaginal smear and seeding of the biomaterial on special media to determine the composition of the vaginal microflora.

Basic principles of therapy

• If fungi are detected in smears: determine the type and sensitivity to fungicidal drugs. The most effective therapeutic agents are selected.
• Measures aimed at restoring the acidity and normal microflora of the vagina - a course of probiotics.
• Treatment accompanying pathologies and boosting immunity.

Self-medication for candidiasis leads to the transition of the acute form of the disease to a chronic recurrent form, to get rid of which you will need long-term therapy with the use of drugs that affect the entire body.

Local treatment is permissible only for acute forms of candidiasis. At chronic course complex therapy is required, combining the use of local drugs and drugs that have a systemic effect on the entire body as a whole.

Periodic exacerbations lead to resumption characteristic symptoms fungal colpitis, inflammation of the genital mucosa.

The drug of choice for recurrent candidiasis is Fluconazole. Doses and treatment regimens are selected by a gynecologist individually for each woman in accordance with the condition of the genital mucosa, severity clinical manifestations, age, presence of underlying diseases.

Fluconazal – antifungal agent, suppressing the growth and reproduction of fungal cells. Well absorbed in the intestines when taken orally.

When symptoms of recurrent thrush appear in women, it is recommended to take three Fluconazole capsules: 1 time per day every three days. It will not be possible to completely free the body from fungi; they are part of the normal biocenosis of the body. The goal of therapy is to inhibit the growth of fungal colonies. After a short course of treatment, the fungi gradually begin to multiply again, and soon the next episode of clinical manifestations occurs, and the treatment is repeated again and again.

In order to interrupt constantly recurring exacerbations of the disease, a method of suppressive therapy has been proposed, when there is no need to wait for the next surge in the activity of the pathogenic agent, but it is necessary to inhibit the growth of fungal colonies by taking Fluconazole daily for six months.

If during all therapeutic and preventive measures clinical picture does not improve, it is possible that fungi have developed resistance to medicinal product. In this case, repeated culture of the vaginal contents is required. Based on the results of the analysis, other drugs are prescribed: Flucostat, Intraconazole. General action drugs are the most effective, since the medicine, being absorbed into digestive tract and entering the bloodstream, it spreads to all organs.

Local therapy

For exacerbations of thrush, triazole-based drugs are used:

Butoconazole is a fungicide that destroys the fungal membrane, increases the permeability of its wall, thereby causing its death. It is used intravaginally in the form of a 2% cream. Retains on the mucous membrane for up to 5 days.

Miconazole - synthetic drug, which has antifungal and anti-inflammatory effects. The fungicidal effect is manifested by inhibiting the biosynthesis of the fungal cell wall. The cell disintegrates, the contents end up in the intercellular space, where they are absorbed by macrophages. Used for vaginal mycosis: one suppository at night. After the symptoms disappear, continue the procedure for another 2 weeks.

The drugs Terconazole and Ketoconazole have a similar effect.

Simultaneously with treatment aimed at reducing toxic effect fungus, probiotics are prescribed. The main task of this group of funds is to provide favorable conditions for the development and colonization of the vaginal mucosa by lactobacilli. The most effective of them:

• Acylact – contains acidophilic lactobacilli, which normalize acidic environment vaginas. Used in the form vaginal suppositories; 2 times a day, 5-10 days.
• Probifor. Taken orally along with lactic acid products.
• Acipol is a multicomponent drug. Take 1 capsule 3 times a day.
• Trilact – contains three types of lactobacilli. Drink 5 ml 2 times a day.

Since recurrent candidiasis is often combined with reduced immunity, immunomodulator drugs are prescribed: Viferon, Polyoxidonium, Immunal.

Vitamin complexes with microelements are also included in the treatment regimen. For intimate hygiene use Lactacid gel, which maintains an optimal vaginal environment.

During treatment you must adhere to healthy image life - quit smoking and alcohol, limit your diet easily digestible carbohydrates(sugar, sweets, chocolate, baked goods). The daily menu should include complete proteins (meat, fish, dairy products), vegetables, and fruits. Avoid spices and spicy foods, because when excreted along with urine, they will irritate the inflamed vaginal mucosa.

In case of irrational treatment, non-compliance with hygiene rules and abstinence from sex during treatment, the fungal infection may spread to the internal genital organs: inflammation in fallopian tubes leads to adhesions and obstruction, which provokes infertility. Weakening protective function vaginal mucosa leads to frequent infectious diseases urogenital zone - cystitis, urethritis, colpitis.

Almost every woman is familiar with the symptoms of thrush and does not consider it serious illness. Many people try to cope with the problem on their own. As a result, this leads to the transition of the acute form of candidiasis to a chronic recurrent form with long-term treatment and deterioration in quality of life.