From the Guidelines
I would consider uterine and pelvic ultrasound in a patient with recurrent thrush to rule out underlying anatomical conditions that may predispose to persistent or recurrent vaginal candidiasis. The primary goal is to identify any structural abnormalities in the reproductive tract that could contribute to recurrent infection, such as uterine fibroids, endometrial polyps, or other conditions that might harbor infection 1. Some key points to consider when evaluating the need for ultrasound in this context include:
- The presence of recurrent thrush may indicate an underlying condition that requires further investigation, such as diabetes, immunosuppression, or hormonal imbalances.
- Ultrasound can help detect anatomical factors that might contribute to recurrent infection, including retained foreign bodies, uterine fibroids, or endometrial polyps.
- The ultrasound should be part of a comprehensive approach that also includes appropriate antifungal treatment and assessment for other risk factors, such as blood glucose testing and HIV screening if indicated.
- While there is limited evidence specifically addressing the use of ultrasound in patients with recurrent thrush, the American College of Radiology suggests that translabial/transperineal ultrasound or side-firing transvaginal probes may provide better visualization than end-firing transvaginal US probes in certain clinical scenarios 1.
- Before ordering an ultrasound, it is essential to ensure that other basic investigations are completed and that the patient has received appropriate antifungal treatment, such as fluconazole 150mg weekly for 6 months for maintenance therapy after initial clearance of infection.
From the Research
Uterine and Pelvic Ultrasound in Recurrent Thrush
- There is no direct evidence to suggest that uterine and pelvic ultrasound is necessary in the management of recurrent thrush 2, 3.
- However, in women with recurrent urinary tract infections, a pelvic examination has been found to provide contributory information in less than 10% of women, and did not change treatment outcomes 4.
- The use of hormones, such as estrogen, has been found to be effective in the treatment of vulvovaginal symptoms and urinary incontinence in postmenopausal women, but the evidence for its use in pelvic organ prolapse is scarce 5.
- In terms of interactions between antifungal medications and hormonal contraceptives, one study found that fluconazole increased the concentrations of ethinyl estradiol and norethindrone, but this increase was not significant enough to pose a threat of contraceptive failure 6.
Considerations for Uterine and Pelvic Ultrasound
- Uterine and pelvic ultrasound may be considered in women with recurrent thrush who also have symptoms of pelvic floor dysfunction, such as urinary incontinence or vaginal bulge symptoms 4.
- However, the decision to perform an ultrasound should be based on individual patient factors and clinical judgment, rather than as a routine part of recurrent thrush management 2, 3.