One of the most unpleasant diseases of the female genital organs is thrush or candidal colpitis (vaginitis). For its treatment, topical agents, such as vaginal suppositories, are widely used. What suppositories are most effective and at the same time allowed during pregnancy?
Thrush is a common disease in women. Almost 75% of women have experienced at least once in their life manifestations of thrush. And for the majority, it occurs more than once.
The disease has an infectious nature. Thrush itself (candidiasis) is not sexually transmitted. However, thrush can sometimes accompany sexually transmitted infections (chlamydia, ureaplasmosis).
Pathogenic fungi of the genus Candida are responsible for the occurrence of thrush. Normally, the surface of the vagina is populated by lactobacilli and bifidobacteria, and fungi of the genus Candida constitute a very small part of its microflora. Under certain conditions, the microflora balance is disturbed and there are too many candida fungi.
Thrush development is promoted by:
- immunity disorders;
- intestinal dysbiosis;
- hormonal disorders;
- improper diet (plenty of sweets in the diet);
- long-term use of antibiotics;
- diabetes;
- excess weight;
- foci of infection in the body, especially in the pelvic area.
Only a gynecologist can diagnose the presence of thrush. For this, he takes an analysis of a sample of microflora from the vagina. The predominance of Candida species in fungi unambiguously indicates thrush.
Why does thrush often develop during pregnancy?
Pregnancy is also one of the factors contributing to the development of the disease. The reasons for the development of thrush during pregnancy are a decrease in immunity during the bearing of a child, as well as in a change in hormonal levels. A decrease in immunity in pregnant women is a natural reaction of the female body to the development of the fetus, which helps prevent its rejection.
During pregnancy, due to hormonal changes and weakened immunity, the fungal microflora multiplies excessively. Thrush occurs. Most often, thrush during pregnancy affects women who have previously experienced candidiasis.
Other factors contributing to the occurrence of thrush during pregnancy:
- lack of vitamins
- frequent constipation
- inflammatory processes in the pelvic organs,
- non-observance of genital hygiene.
Symptoms of thrush during pregnancy
Thrush gives a pregnant woman a lot of inconvenience. The main symptoms of thrush are itching and burning, copious cheesy discharge and an unpleasant odor from the vagina. Many pregnant women may also have swelling of the mucous membranes, drawing pain in the lower abdomen. Urination is accompanied by pain and burning, intercourse becomes painful.
Itching, pain and burning with thrush can lead to neurosis and insomnia in pregnant women. This negatively affects the health of not only the mother, but also her baby.
Diagnosis of thrush during pregnancy
Vaginitis can be caused by various causes and pathogens. Therefore, often the presence of only symptoms of itching, burning and unusual vaginal discharge is not enough to speak with confidence about the presence of thrush. Diseases such as trichomoniasis and bacterial vaginosis resemble thrush in their symptoms. A wrong diagnosis in pregnant women can make it difficult or even impossible to treat.
Therefore, a gynecologist should be involved in the diagnosis of thrush. He will not only analyze the symptoms, but also conduct a series of studies. These include taking a smear and examining it with a microscope or isolating the pathogen with a backseeding. The PCR method can also be used, but this is an expensive procedure and is rarely used for suspected candidiasis. Having identified the degree of development of thrush, the doctor will prescribe the desired drug, taking into account the gestational age.
Why is it necessary to use candles to treat thrush during pregnancy?
During pregnancy, a woman needs to take care not only about her health, but also about the health of the unborn child. For this reason, systemic drugs taken orally are prohibited for the treatment of thrush during pregnancy. This is due to the fact that almost any drugs are able to penetrate the placenta and affect the baby’s body.
Consequently, the only treatment for thrush during pregnancy is local drugs such as suppositories, solutions and ointments. The use of intravaginal suppositories in pregnant women has undeniable advantages. A candle placed in the vagina can have a therapeutic effect for a long period of time. Suppositories with thrush begin to act immediately after being placed in the vagina, in contrast to oral tablets, the effect of which becomes noticeable only after some time.
In addition, when using local agents to treat thrush, the active substances directly penetrate the local bloodstream. Their effectiveness is maximum, since the active substance is immediately evenly distributed over the mucous membranes, and its loss does not occur in the body.
There is another advantage of local drugs in the treatment of thrush – the absence of a load on the liver and kidneys, toxic effects on the whole body. If allergic reactions occur during treatment with local drugs, they do not affect the whole body and appear only at the local level. In the case of vaginal suppositories, this may be a slight burning sensation and itching, irritation of the mucous membranes.
The disadvantages of local preparations for the treatment of thrush include perhaps the need to install candles and tablets, as well as the fact that the oily base of suppositories can leak out, dirty linen. Vaginal tablets are deprived of this drawback.
The composition of candles from thrush
The basis of suppositories are usually fatty acids. Also, suppositories from thrush always include substances that kill candida fungi.
The most common of these compounds:
- ketoconazole,
- clotrimazole
- sertaconazole,
- miconazole
- natamycin
- nystatin
- econazole
- butoconazole,
- povidone iodine
- chlorhexidine
- dequalinium chloride,
- fluconazole.
Clotrimazole
A frequent component of suppositories from thrush. Belongs to the chemical group of imidazoles. It has activity against fungal microflora, as well as Trichomonas. Clotrimazole suppositories can be used starting from the second trimester of pregnancy. The disadvantage of clotrimazole is the possible development of drug resistance in fungi.
Ketoconazole
Substance from the group of imidazoles. Similar to clotrimazole. Prevents the formation of the cell membrane of microorganisms, which leads to their death. Active against yeast, streptococci and staphylococci. It is part of many suppositories intended for the treatment of thrush. It is contraindicated in the first trimester of pregnancy, in the second and third trimesters it is prescribed with caution. Ketoconazole is part of the Livarol suppository.
Miconazole
An antifungal drug of the imidazole group, often used in the treatment of thrush. Effective against candida fungi, dermatophytes. The action is based on a violation of the synthesis of components of the cell walls of fungi. It is not approved for use in the first trimester of pregnancy, in the second trimester, the drug is used if the benefit to the mother is much higher than the expected risk to the fetus. Miconazole is part of the suppository:
- Ginesol 7,
- Neo-Penotran Forte,
- Klion-D.
Econazole
The drug is an imidazole group that is active against candida fungi that cause thrush. Almost not absorbed into the systemic circulation when applied topically. During pregnancy, local preparations with econazole can be used in the second and third trimesters only if the potential risk to the fetus is less than the benefit to the mother. Included in the composition of Gino-Pevaril.
Natamycin
This substance belongs to the pharmacological group of macrolide antibiotics. However, natamycin is active not only against bacteria, but also against yeast fungi. Moreover, so far no cases of the development of resistance to the antibiotic from microorganisms have been recorded. When pregnancy is used with caution, in the absence of alternatives. The drug can be prescribed to pregnant women in the first trimester, when many other drugs are prohibited. Natamycin is part of many suppositories from thrush:
- Pimafucin,
- Ecofucin,
- Primafungin,
- Natamycin.
All of these products contain 100 mg of natamycin.
Povidone iodine
This compound also has antifungal activity and therefore can be used for thrush. Iodine attacks the cells of the fungus, binds to its proteins and causes its death. Suppositories with povidone iodine can be prescribed in the first trimester of pregnancy. However, in the third trimester, drugs with iodine for the treatment of pregnant women are prohibited. This is due to the fact that iodine can penetrate the placental barrier and accumulate in the baby’s body. This can adversely affect the formation of his thyroid gland. Povidone iodine is part of the Betadine and Iodoxide suppositories.
Sertaconazole
A modern antifungal drug has the greatest effect among all antifungal agents. Often used to treat vaginal candidiasis in pregnant women. It has fungicidal and fungistatic effects, increases the permeability of the walls of microorganisms, which leads to their death. Sertaconozole is active against thrush-causing candida fungi, dermatophytes, and many gram-positive bacteria. Does not affect the activity of lactobacilli. When applied topically, it is not found in blood and urine. It is part of Zalain, often used to treat vaginal candidiasis in pregnant women.
Nystatin
One of the oldest antifungal compounds. Particularly effective against candida fungi. Despite the fact that the drug has been used since the middle of the last century, microorganisms have not developed resistance to it. The drug, when applied topically, is little absorbed into the systemic circulation. Nystatin is not recommended during pregnancy, but suppositories with nystatin can be used in the second and third trimesters with the permission of a doctor. Nystatin is part of the suppositories Polygynax and Macmirror Complex.
Dequalinium chloride
Antibacterial and antifungal drug with a wide spectrum of action. Active against thrush-causing candida fungi, streptococci and staphylococci, Trichomonas. When applied topically, absorption into the systemic circulation is minimal. Therefore, vaginal suppositories with dequalin can be used throughout the gestation period. Dequalinium chloride is a part of Fluomizinum.
Rules for the use of suppositories
There are suppositories that can be used only at the beginning of pregnancy, while other drugs can be used in the 2nd and 3rd trimester. Pregnancy requires a careful selection of drugs. Despite the fact that suppositories act locally, a certain proportion of the substances from them can enter the systemic circulation.
Before entering a suppository or vaginal tablet, you need to thoroughly wash your hands – in order to inadvertently not bring any infection other than candida fungi. It is best to administer suppositories for thrush overnight. This is due to the fact that in a dream a woman is in a supine position, therefore, the suppository is less likely to fall out. Enter the candle also in the supine position. At the same time, it is necessary to strive to ensure that it is installed as deep as possible, but so that it does not cause pain. After installing the candles, it is best to lie down for 30-50 minutes.
Before using the selected suppository, you must read the instructions, since all drugs have their own characteristics of use.
The course of treatment for thrush during pregnancy usually lasts 1-2 weeks, less often 3 weeks. You can not interrupt the course, even if the symptoms of thrush ceased to be felt.
However, if the selected drug leads to allergic reactions, the pregnant woman must stop therapy and consult a doctor. An allergic reaction may be indicated by increased burning itching and discomfort in the vagina. In this case, the installed candle should be pulled out. If this is not possible, the vagina should be rinsed with a solution of soda.
Why is it necessary to treat thrush during pregnancy?
Thrush does not pose a threat to the life of the mother and fetus. However, this disease in pregnant women is fraught with many dangers and inconveniences.
Thrush is unpleasant, first of all, in that it gives the woman psychological discomfort, which is undesirable during pregnancy. Thrush can also lead to a decrease in immunity, the spread of infection in other organs.
If in the first half of pregnancy the treatment of the disease is not always required, then before delivery the thrush must be cured. If this is not done, then the infection can interfere with the recovery of the body after childbirth, and, in particular, interfere with the healing of wounds resulting from cesarean section. As a result, the risk of birth bleeding increases. Also, with thrush, the infection can enter the baby’s body – before or during childbirth. The probability that the baby will be infected at the time of birth is very high – up to 90%.
You can’t try to cure thrush during pregnancy yourself. And the reason lies precisely in the fact that not all drugs are suitable for the treatment of thrush during pregnancy, and some suppositories cannot be used at certain stages of pregnancy.
Additional treatments for thrush during pregnancy
Treatment is not limited to the use of suppositories. Pregnant women suffering from thrush, you must also follow a diet. The development of fungi contributes to foods rich in sugars, therefore, it is necessary to limit the amount of sweets in the diet. It is also necessary to take vitamin complexes.
It is worth remembering the right choice of underwear. Women’s underpants should be made only of natural materials and not be cramped. These factors provide good ventilation of the intimate area of the body of a pregnant woman. It is necessary to remember about the regular change of linen. And sanitary pads should be discarded.
Hygienic procedures of the genitals should be limited only to external washing, douching of the vagina with thrush is prohibited. It is also necessary to abandon sexual life, especially since sexual intercourse with thrush causes a woman great discomfort. Strong physical exertion, stress should also be avoided.
To restore the normal microflora of the vagina with thrush, probiotic suppositories containing bifidobacteria and lactobacilli can also be prescribed. These are Vagilak, Lactobacterin, Vaginorm C, Bifidumbacterin.
Which suppositories from thrush for pregnant women are best suited?
In pharmacies, many varieties of drugs that are effective for thrush are sold. However, it is impossible to say in advance which suppositories are best for a pregnant woman in a particular case. Many women tend to choose a drug based on the advice of friends or from advice on online forums and social networks. However, such an approach can hardly be called correct. It is best to consult a doctor who will examine the pregnant woman and will be able to suggest the best option.
Characteristics of suppositories and vaginal tablets used in the treatment of thrush during pregnancy
Betadine
Popular suppositories containing the antiseptic povidone iodine. They have a torpedo shape. Produced in Hungary. Betadine can be used to treat pregnant women in the first and second trimesters. Povidone iodine is released gradually, which determines the long-term effect of the drug.
The presence of iodine in Betadine determines its contraindications – this is an increased activity of the thyroid gland (hyperthyroidism) and other thyroid dysfunctions, the simultaneous administration of iodine preparations, as well as the third trimester of pregnancy, when the thyroid gland begins to function in the baby. In any case, if the pregnant woman used Betadine, then after the birth of the baby, it is necessary to check the state of his thyroid gland.
In case of acute thrush of a pregnant woman, it is recommended to use 1-2 candles per day (at bedtime) for a week, in chronic – 1 candle for 2 weeks. Before administration, suppositories must be moistened in water.
Betadine is incompatible with other antiseptic agents, reduces the effectiveness of hydrogen peroxide, preparations containing silver. Regular use of the drug should be avoided in patients taking lithium preparations. Betadine is prescribed with caution to women with renal failure.
Hexicon
Available in the form of tablets and suppositories. Hexicon contains a broad-spectrum antiseptic chlorhexidine, which affects both bacteria and fungi (although its antifungal effect is relatively weak). Therefore, most often, Hexicon is prescribed for mild thrush and in cases where vaginal mycosis is combined with ureaplasmosis and chlamydia. Chlorhexidine does not penetrate the systemic circulation at all, therefore suppositories and tablets can safely be used for thrush during pregnancy at any time. Often, the drug is prescribed immediately before birth. It can be used in pregnant women and for preventive purposes. The course of treatment is long – up to 10 days. 2 candles are introduced per day.
Ginesol 7
The preparation contains an active antifungal component – miconazole (100 mg). The drug quickly has an effect and relieves the pregnant woman of the symptoms of thrush. Allowed from the second trimester of pregnancy. Candles must be placed at night, one per day. The course of treatment is 6-7 days.
Gino-Pevaril
Contain econazole as an active substance. Each candle may contain 50 or 150 mg of econazole. This compound is able to actively destroy the cell walls of fungi, as a result of which they die. A 150 mg suppository is administered once at night for 3 days. However, if after a week the pathogens are still found in the vagina, a second course of treatment is necessary. Suppositories 50 mg are prescribed for a period of 2 weeks. In the first trimester of pregnancy, the use is not recommended, since econazole is able to partially penetrate into the systemic circulation. In the second and third trimester, the drug is used with caution.
Zalain
Hungarian drug containing the antifungal agent sertoconazole, which is also effective against streptococci and staphylococci. A suppository for the treatment of thrush can be used once by injecting it into the vagina at night. If the risk of relapse is high, then the drug can be reused after a week. Zalain, given the single use and lack of systemic absorption of sertoconazole, is allowed in any period of pregnancy. Of the shortcomings, only the high cost of the product can be noted – one candle costs at least 500 p.
Ketoconazole
The drug is produced by several Russian pharmaceutical companies. Candles have a cylindrical shape with a pointed end. Each suppository contains 400 mg of the antifungal drug of the same name. The remaining volume is occupied by semisynthetic glycerides, which create the fat base of the suppository. The drug is indicated for acute and chronic thrush. With caution, it can be used in the second and third trimesters of pregnancy. In the first trimester, suppositories are prohibited. Apply one candle per day. In acute candidiasis, the course of treatment is 3-5 days, in chronic – 10 days.
Klion-D
The manufacturer of the drug is the pharmaceutical company Gideon Richter. These are vaginal tablets containing the antibiotic metronidazole and the antifungal agent miconazole. This combination provides a wide range of effects of the drug. Klion-D is especially effective for thrush complicated by gardnerellosis and trichomoniasis. It is contraindicated in the first trimester of pregnancy, in the second and third trimesters it is prescribed with caution. At night, one tablet is introduced, previously moistened in water. The course of treatment is 10 days.
Clotrimazole
Available in the form of vaginal tablets or suppositories with a fat base. Any form of the drug contains the active substance of the same name (100, 200 or 500 mg) from the group of imidazoles, active against Candida fungi and Trichomonas. Before use, the tablets must be moistened in warm water. The drug is not recommended for use in the first trimester of pregnancy.
2 tablets of 100 mg per day are used for 3 days, or 1 time per day for 6-7 days. 200 mg tablets are prescribed to a pregnant woman in 1 piece for 3 days. A 500 mg tablet is used once. In the case of suppositories, one candle is used at night for 6 days. Longer treatment is not recommended.
The drug has a low price. Among the shortcomings can be noted the rapid addiction of fungi to clotrimazole. Therefore, if after a course of treatment a relapse of thrush occurs, gynecologists advise changing the drug. In addition, clotrimazole reduces the effectiveness of other antifungal drugs – nystatin and natamycin.
Livarol
The active substance is ketoconazole. The drug is produced in Russia (Nizhpharm company). The duration of treatment is up to 10 days. One suppository is used per day (at bedtime). Full recovery can occur already on 3-5 days of using the drug, and many symptoms disappear after the first use. It can be used during pregnancy (except for 1 trimester).
McMirror complex
The preparation is Italian made in the form of suppositories (capsules). It contains 2 active ingredients – nystatin and nifuratel. It has antifungal and antibacterial effects. Often used if thrush is complicated by a bacterial infection. A pregnant woman is prescribed one suppository per day (at night), the course of treatment is 8 days. Capsules are covered with a gelatin shell, which prevents hand contamination when installing the suppository. It can be used at any time during pregnancy, but only in cases where the risk to the fetus is low and the benefit to the mother is undeniable.
Neo-Penotran Forte
A combined preparation containing metronidazole and miconazole. The action of Neo-Penotran is complex, it is able to act both on candida fungus and bacteria (Trichomonas, gardnerella, anaerobic streptococci). There is also a variant of the drug Neo-Penotran Forte L, containing lidocaine, which has a local analgesic effect.
These suppositories from thrush must be installed as deep as possible in the vagina. To facilitate this operation, the package contains disposable fingertips. It is recommended to use 2 suppositories per day (morning and evening). The course of treatment is 7 days, in case of relapse – 14 days. In the first trimester of pregnancy can not be used. The drug is also not used in patients with severe liver failure.
Pimafucin
Vaginal suppositories torpedo-shaped Italian production. Often used to treat thrush in pregnant women. The composition of Pimafucin includes the antibiotic natamycin, which also exhibits antifungal activity. It is known that pathogenic fungi almost never develop resistance to natamycin. The suppositories are based on cetyl alcohol, solid fat, sorbitan trioleate, polysorbate 80, sodium bicarbonate, adilic acid. Under the influence of the heat of the human body, candles quickly dissolve, forming a foamy mass, and the drug is evenly distributed over the surface of the mucous membrane. The suppository is administered once a day (at night). The course of treatment is 3-6 days. The drug can be used throughout pregnancy.
Polygynax
The drug is available in the form of vaginal capsules. They contain nystatin, neomycin and polymyxin B as active substances. Nystatin is an antifungal drug, and neomycin and polymyxin B are antibiotics. Such a selection of active substances provides a wide spectrum of action of Polygynax. With thrush, it is recommended to use 1 capsule per day (at bedtime), the course of treatment is 12 days. With prevention, a shorter course is recommended – 6 days.
Terzhinan
Produced by a French pharmaceutical company. Terzhinan – a complex drug for thrush, containing:
- ternidazole
- neomycin,
- nystatin
- prednisone.
Ternidazole and neomycin are antibiotics, nystatin is an antifungal, and prednisolone is an anti-inflammatory drug from the category of glucocorticosteroids. Thus terzhinan has a bactericidal, antifungal and anti-inflammatory effect.
Available in the form of vaginal tablets. Before use, the tablets must be soaked. One tablet is administered per day (preferably at night). At the first use, a slight burning sensation is possible, which usually disappears soon and is not a reason for drug withdrawal. The drug is approved for use, starting from the second trimester of pregnancy, in the first it can be prescribed with caution. The course of treatment is 10 days, in some cases it can be extended up to 20 days.
Fluomizine
The drug is an oval biconvex vaginal tablet. They are produced by the Swiss pharmaceutical company Medina. The active substance of the tablets is dequalinium chloride. The drug is contraindicated in patients under the age of majority. Also, suppositories are prohibited with erosion or violation of the integrity of the vaginal mucosa. The drug is allowed throughout pregnancy, but is prescribed with caution in the first and second trimester. Most often, tablets are treated in the third trimester. The duration of the course is 6 days.
Ecofucin
Suppositories from thrush Ecofucin contain natamycin, as well as lactulose, which plays the role of a prebiotic, while maintaining the beneficial microflora of the vagina. Made in France. One candle contains 100 mg of natamycin. Perhaps the use during pregnancy (in all trimesters). A pregnant woman is prescribed one suppository at night for 3-6 days.
What suppositories are best used during certain periods of pregnancy?
In the first trimester, suppositories containing povidone iodine and natamycin are most often used. It:
- Pimafucin,
- Ecofucin,
- Betadine.
In the second trimester, more drugs are already allowed. Suppositories based on:
- ketoconazole
- clotrimazole
- sertoconazole,
- miconazole
- econazole.
In addition, some combination drugs are used (Terzhinan, Klion D, Macmirror-Complex).
The best drugs for the second trimester:
- Terzhinan,
- Clotrimazole
- Zalain,
- Ketoconazole
Before childbirth, it is possible to use drugs with a gentle effect for preventive purposes, even if the woman does not have thrush.
The best suppositories for the third trimester
- Hexicon
- Livarol
- Polygynax,
- Fluomizine.
What suppositories can not be used during pregnancy?
In all periods of pregnancy, drugs with fluconazole (Flucostat, Diflucan) and butoconazole (Ginofort) are prohibited. It was revealed that fluconazole can adversely affect the fetus in any trimester. Fluconazole increases the likelihood of miscarriage, can lead to a delay in fetal development or to abnormalities in the development of the fetus (heart defects, cleft lip, cleft palate), premature birth.
With intravaginal use, butoconazole is able to partially penetrate the systemic circulation, and then into the baby’s body. Animal experiments have convincingly shown that this drug can disrupt the normal course of pregnancy. Therefore, doctors prefer not to take risks and do not prescribe drugs with butoconozole to pregnant women.
What suppositories can not be used in certain trimesters of pregnancy?
Drugs that can not be used in the first trimester:
- Ketoconazole,
- Ginesol 7,
- Neo-Penotran Forte,
- Livarol
- Clotrimazole
- Polygynax,
- Gino-Pevaril,
- Klion-D.
Almost all suppositories, except those containing fluconazole and butoconazole, can be used in the second trimester.
The same applies to the third trimester. However, there is one exception. Betadine, as well as other drugs containing povidone-iodine, should in no case be used in the third trimester, since they can adversely affect the baby’s thyroid gland.
Which suppositories are the safest?
Most drugs can not be used without the advice of a doctor, as they contain substances that can potentially penetrate the bloodstream and reach the fetus. Therefore, the doctor assesses the health risks of women that come from the disease itself and compares them with potential harm to the fetus. If the thrush causes significant discomfort, and the likelihood of side effects associated with the course of pregnancy and the condition of the fetus is small, then the doctor prescribes vaginal suppositories. Particular care must be taken when using drugs containing substances from the class of imidazoles, as well as nystatin.
Nevertheless, there are relatively safe drugs that, even in theory, do not pose a danger to the baby. These include Hexicon (however, it is not always effective), drugs based on sertoconazole (due to a short course of treatment), natamycin, fluomizin. Of course, before using these drugs it is also necessary to consult a doctor, as they have a number of side effects, and their uncontrolled use can only cause harm.
