From the Guidelines
Uterine and pelvic ultrasound, specifically transvaginal ultrasound, should be considered in patients with recurrent thrush to rule out underlying structural abnormalities that may contribute to persistent vaginal candidiasis. This approach is supported by the most recent evidence, which emphasizes the importance of imaging in evaluating pelvic pain and suspected gynecologic conditions 1.
Rationale for Transvaginal Ultrasound
The rationale behind choosing transvaginal ultrasound lies in its ability to provide higher resolution images of the pelvic organs compared to transabdominal ultrasound. This modality allows for better visualization of the uterus, endometrium, ovaries, and surrounding structures, which is crucial for identifying conditions such as retained intrauterine devices, endometrial polyps, fibroids, or ovarian cysts that might create an environment favorable for recurrent fungal infections 1.
Diagnostic Considerations
Transvaginal ultrasound is particularly valuable for detecting more serious pathologies like endometrial hyperplasia or malignancies that might present with symptoms similar to recurrent thrush. The procedure is relatively quick, minimally invasive, and requires only limited preparation, typically an empty bladder. For patients experiencing recurrent thrush despite appropriate antifungal therapy, such as fluconazole 150mg weekly for 6 months, this imaging can be an important diagnostic step to ensure no underlying anatomical factors are contributing to treatment failure.
Evidence Support
The evidence from recent studies supports the use of ultrasound, particularly a combined transabdominal and transvaginal approach, as the most useful imaging modality for initial assessment when a gynecological etiology is suspected 1. While transabdominal ultrasound has its benefits, including a larger field of view and better tolerance by patients, transvaginal ultrasound offers superior visualization of the pelvic organs, making it the preferred choice for evaluating conditions related to recurrent thrush.
Clinical Application
In clinical practice, the decision to perform a uterine and pelvic ultrasound, specifically transvaginal, in patients with recurrent thrush should be based on the presence of symptoms suggestive of underlying structural abnormalities or conditions that may contribute to persistent vaginal candidiasis. Given the minimally invasive nature and the diagnostic value of transvaginal ultrasound, it is a reasonable next step in the management of recurrent thrush, especially when other treatments have failed to resolve the condition.
From the Research
Uterine and Pelvic Ultrasound in Recurrent Thrush
- Uterine and pelvic ultrasound may be considered in patients with recurrent thrush to rule out underlying anatomical abnormalities that may be contributing to the recurrence of thrush 2.
- Transvaginal ultrasound is a commonly used imaging modality for assessing the female reproductive organs, including the uterus and pelvic floor 2, 3, 4.
- It can help identify abnormalities such as urethral diverticula, periurethral masses, and distension cystoceles, which may be associated with recurrent thrush 2.
Diagnostic Parameters of Transvaginal Ultrasound
- Transvaginal ultrasound has been shown to have high specificity and negative predictive value for detecting urinary tract involvement in women with gynecological cancers 4.
- However, its sensitivity for detecting ureteral infiltration is lower compared to other parameters such as bladder wall infiltration and vesico-uterine septum infiltration 4.
- In the diagnosis of pelvic endometriosis, transvaginal ultrasound has been shown to have inferior diagnostic parameters compared to pelvic MRI examinations 3.
Clinical Applications of Transvaginal Ultrasound
- Transvaginal ultrasound is a simple and non-invasive method for assessing the urinary tract in women with gynecological cancers 4.
- It can be used to evaluate the ureters, vesico-uterine septum, and bladder involvement, and can help plan the management of patients with gynecologic cancers 4.
- However, its clinical applications may be limited compared to other imaging modalities such as pelvic MRI examinations, especially in the diagnosis of pelvic endometriosis 3.