Which probiotics help with thrush? | Professionals (2024)

Dr Aisling Dwyer MB BCh BAO (Medicine, Surgery and Obstetrics), MSc (Personalised Nutrition)

Thrush is a very common health issue which affects 130 million women worldwide every year¹. It can be a source of discomfort and frustration for many women.As such, more individuals are looking for natural options to help manage their symptoms and prevent recurrent infection. Probiotics have become a popular option. However, identifying the right probiotic to help combat thrush is important as some are much more effective than others.Some of the most well researched probiotic strains shown to help with thrush in clinical trials areLactobacillus reuteriRC-14^®andLactobacillus rhamnosusGR-1^®. Find out more about the best strains for female intimate health in this article on our Probiotics Learning Lab'Which Probiotics are best for Women?'

In this article we will look at:

What is thrush?

Thrush is a fungal infection caused by a pathogenic (harmful) yeast. This can occur in the mouth (oral thrush) or in the genital area (vulvo-vagin*l thrush). The typical symptoms of vagin*l thrush include:

vagin*l discharge - creamy white, “cottage cheese -like”, usually odourless
Itching and irritation of the intimate area affecting the labia and entrance to the vagin*
Severe cases – skin breakdown and excoriation
Other potential additional symptoms – pain during intercourse, discomfort/burning when urinating, sometimes asymptomatic

Women can often suffer with multiple bouts of thrush, the recurrence rates are quite high with a prevalence of 9% of women suffering between the ages of 25 to 34 years globally¹. Traditional medical treatment involves the use of topical anti-fungal creams, anti-fungal pessaries or oral anti-fungal tablets. However, extensive use of these is contributing negatively to an already increasing rate of anti-fungal resistance in Candida albicans². To find out about probiotics and how they can help, read this articleWhat are probiotics?in the Probiotics Learning Lab.

What are the causes of thrush?

Thrush is typically caused by a pathogenic yeast known as Candida. Candida spp. lives naturally in the body - within the intestines, mouth, skin and vagin*. In low numbers, they are usually considered harmless. The most common species of Candida that can cause thrush is Candida albicans. Find out more aboutCandida albicans.

Candida albicans (C. albicans) may increase in number when there is an imbalance, known as dysbiosis, in the microbiome. The human microbiome is the name given to the microbes that live on or within the human body including bacteria and yeasts. Collectively, they form an ecosystem. There is usually a delicate balance between the beneficial microbes and pathogenic microbes in our microbiome. Symptoms of thrush may develop when there is an overgrowth of C. albicans in the mouth or genital area. This overgrowth is believed to occur as a result of a disruption to our microbiome, leading to dysbiosis. This disruption may occur due to factors such as:

Medication use - antibiotics, oral contraceptive pill³ or hormonal replacement therapy⁴, corticosteroids⁵
Fluctuations in hormone levels such as during pregnancy³. Disruption of the natural pH balance of the vagin* caused by local factors such as use of scented intimate products and soaps
Underlying medical conditions such as diabetes mellitus⁶
Dietary habits – excessive alcohol consumption, high sugar/low fibre diets
Sexual activity⁷

The vagin*l microbiome is unique and differs from the oral and gut microbiome. A healthy vagin*l microbiome should be dominant in the bacteria, lactobacilli. Lactobacilli can exert many protective effects to promote a healthy vagin*l tract and reduce the risk of infections. When their levels are depleted, an imbalance may occur and opportunistic pathogens such as C. albicans can thrive.

Can probiotics help with thrush?

Yes, probiotics may help with managing thrush. Clinical studies have shown that optimising one's friendly bacteria with probiotics can help to maintain a healthy vagin*l microbiome.However, probiotics work in different ways - many work predominately in the gut. Not all lactobacilli will even reach the vagin*l tract. It’s important to find probiotic strains that have evidence for vagin*l colonisation and have clinical trials against thrush. Two strains that may help with thrush are Lactobacillus reuteri RC-14^®and Lactobacillus rhamnosus GR-1^®. Both of these strains can be foundin Optibac For Women.

You may like to read further research behind these strainsLactobacillus reuteri RC-14®and Lactobacillus rhamnosus GR-1®on the Probiotics Database.

Does live yoghurt help with thrush?

Live yoghurts are a good source of friendly bacteria. It is beneficial to consume probiotic foods, such as live yoghurt, to boost our overall general health. Keeping our gut microbiome healthy by eating live yoghurt, will in turn help our vagin*l microbiome, and help avoid an imbalance that could lead to thrush. However, the probiotic bacteria that are present in live yoghurt are not specific for vagin*l health, and may not even reach the intimate area. Using a probiotic supplement that has been clinically researched for supporting vagin*l health, may provide a much more targeted approach when managing thrush.

How do probiotic supplements help prevent thrush?

Lactobacillus reuteriRC-14^®andLactobacillus rhamnosusGR-1^®have been shown to have anti-fungal properties. Both strains can produce lactic acid, this helps to lower the pH in the vagin*l tract (pH 4 or below). This acidity creates an unfavourable environment for C. albicans, thus limiting growth. The probiotic strains can also adhere to the vagin*l lining and create a physical barrier limiting the space and nutrients available for C. albicans (known as competitive inhibition)¹⁰. Furthermore, both strains may reduce inflammation associated with C. albicans infection. These strains inhibited the growth of Candida albicans through the production of anti-fungal, lactic acid and competitive inhibition, by utilising space and nutrients Candida albicans requires to grow.

Whichis the best probiotic for thrush?

A number of clinical trials testing a combination of two particular probiotic strains,Lactobacillus reuteriRC-14^®andLactobacillus rhamnosusGR-1^®have been shown to be beneficial in supporting vagin*l health. The best probiotics for yeast infectionsinclude thetwo strains of bacteria,L. reuteriRC-14^®andL. rhamnosusGR-1^®, which are some of the most researched probiotics to date, and are certainly the most researched in terms of women's intimate health.

In a RCT by Martinez et al. 2009, 55 women diagnosed with vulvovagin*l candidiasis were divided into two groups; one group received 2 billion CFU of Lactobacillus reuteriRC-14^®andLactobacillus rhamnosusGR-1^®and the other group received a placebo for 4 weeks. Both groups initially were given 150mg of oral fluconazole. There was a significant reduction in vagin*l discharge which corresponded with a reduction in yeast cell counts on vagin*l swabs. More subjects with recurrent infection tested positive for Candida spp. on vagin*l swabs compared with the probiotic group at the end of the 4 weeks (80% and 18.2% respectively)⁸. This shows that use of these two strains of probiotic bacteria alongside conventional oral anti-fungal medication can be beneficial for yeast infections.In further studies by Anukam et al. 2009, oral supplementation with these two strains alongside conventional treatment resulted in reduced recurrence of future infections⁹.

You may like to read about furtherresearch behind these two strains on the Probiotics Database behindLactobacillus reuteriRC-14®andLactobacillus rhamnosusGR-1®.Both of these strains are in Optibac For Women.

Reducing the risk of thrush

Other lifestyle factors may need to be considered when managing or reducing the risk of thrush

Try to avoid:

Tight-fitting underwear and tights
Perfumed soaps and shower gels including products marketed specifically for the vagin*
Alcohol and high sugar foods.

Choose:

A good quality probiotic specifically researched for women’s intimate health
Cotton underwear rather than synthetic materials
To wash the intimate area with water alone or with a clean, wet cloth

Can men get genital thrush?

Although less common, it is possible for men to get thrush. The causeof thrush in men is usually an overgrowth of the yeast-like fungus, Candida albicans. Symptoms include itching, burning, irritation and redness of the penis. Currently, there are no genital probiotics which are studied for thrush in men, however, men with thrush could consider supporting their gut health. Our article 'Which probiotics are best for Candida?'can provide helpful tips and guidance on how to do this.

Oral thrush

The above information relates predominantly to vagin*l thrush. More scientific research is needed but preliminary studies do support the theory that probiotics could have a role to play in the management of oral thrush. As a health care professional you might find the following blog post interesting:Could probiotics help with oral thrush?

Summary

Vulvovagin*l thrush is caused by an overgrowth of Candida, most commonly Candida albicans.
Due to high recurrence rates, women are seeking alternative options to traditional treatments, including probiotics for yeast infections, to help manage their symptoms.
Supporting a healthy vagin*l microbiome can help to correct imbalance of Candida spp. overgrowth.
Identifying a probiotic that reaches the vagin*l tract and has clinical evidence against thrush in particular is important.
A healthy vagin*l microbiome which is high in lactobacilli may protect against gynaecological infections such as thrush.
Specific probioticstrains, Lactobacillus reuteriRC-14^®andLactobacillus rhamnosusGR-1®, have promising clinical research for their role in supporting vagin*l health.

References

Denning, D. W., Kneale, M., Sobel, J. D., & Rautemaa-Richardson, R. (2018). Global burden of recurrent vulvovagin*l candidiasis: a systematic review. Lancet Infect Dis, 339-347.
Berkow, E. L., & Lockhart, S. R. (2017). Fluconazole resistance in Candida species: a current perspective. Infection and Drug Resistance, 237-245.
Jacob, L., John, M., Kalder, M., & Kostev, K. (2018). Prevalence of vulvovagin*l candidiasis in gynecological practices in Germany: A retrospective study of 954,186 patients. Current Medical Mycology, 6-11.
Fischer, G., & Bradford, J. (2011). Vulvovagin*l Candidiasis in postmenopausal women: the role of hormonal replacement therapy. Journal of Lower Genital Tract Disease, 263-267.
Farhan, M. A., Moharram, A. M., Salah, T., & Shaaban, O. M. (2019). Types of yeasts that cause vulvovagin*l candidiasis in chronic users of corticosteroids. Medical Mycology, 681-687.
Rodrigues, C. F., Rodrigues, M. E., & Henriques, M. (2019). Candida spp. Infections in Patients with Diabetes Mellitus. Journal of Clinical Medicine.
Foxman, J. (1990). The Epidemiology of Vulvovagin*l Candidiasis: Risk Factors. American Journal of Public Health.
Martinez et al., (2009), ‘Improved treatment of vulvovagin*l candidiasis with fluconazole plus probioticLactobacillus rhamnosusGR-1®andLactobacillus reuteriRC-14®’.Lett. Appl. Microbiol., 48(3): 269-74.
Anukam et al., (2009), ‘Oral use of probiotics as an adjunctive therapy to fluconazole in the treatment of yeast vaginitis: A study of Nigerian women in an outdoor clinic’.Microb. Ecol. Health Dis., 21(2):72-77.
Kohler, G. A., Asseifa, S., & Reid, G. (2012). Probiotic Interference of Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 with the Opportunistic Fungal Pathogen Candida albicans. Infectious Diseases in Obstetrics and Gynaecology.

This article was written byDr Aisling DwyerMB BCh BAO (Medicine, Surgery and Obstetrics), MSc (Personalised Nutrition) in collaboration with Kathy Wheddon (Nutritional Therapist DipION)

Article Updated: 12 Jul 2023 Originally Published: 23 Apr 2020