Amanda, medicines sales assistant at the OTC Pharmacy, is at home one morning when her next door neighbour Maddie calls at her door. After a bit of chatting Maddie says: ”Amanda, the real reason I’ve come to you is to ask a favour. When you go into work this afternoon can you get me one of these?” She shows Amanda an empty box of a clotrimazole pessary and cream combipack for thrush. “I can’t get out because my washing machine’s broken down and I’ve got to wait in for the repair man.”
 
“Is it for you then?” Amanda asks. “No, it’s for Danielle*?”
“Has she had thrush before?” “No.”

“So how do you know it’s thrush?” Amanda asks.

“Well, we all know the symptoms, don’t we? We’ve all had it often enough, haven’t we? At least I have.”

“What symptoms has she got then?”

“You know, the usual ones. She says she’s very itchy down below and she’s got a thick white discharge.”

 “Really Maddie,” says Amanda, “I think you ought to take Danielle to the doctor.”

“But that’s part of the reason I’ve come to you. She’s too embarrassed to go, she doesn’t want to be examined. And anyway, I’m sure that it’s thrush that she’s got, so why bother?”

“Look, Maddie,” Amanda replies, “I don’t want to seem unneighbourly or anything, but I really can’t get the pessary for you. Let me tell you why.”
* Maddie’s daughter, aged 15.


Questions

1. What are the two reasons why Amanda cannot get the clotrimazole combipack for Danielle?
2. What are the other reasons for not supplying clotrimazole products or a fluconazole capsule for thrush, without a prescription?
3. Apart from what Maddie has described, what other signs or symptoms of thrush are there?
4. What causes thrush?
5. What factors can encourage or trigger thrush?





Answers

1. The minimum age for supplying without a prescription is 16 years. The girl or woman has to have had thrush diagnosed by a doctor previously, treatment can be supplied OTC for further attacks after that.

2. More than two attacks of thrush within the previous six months; women over 60; pregnant or breast-feeding; abnormal or irregular vaginal bleeding; any blood staining of vaginal discharge; any sores, ulcers or blisters on the vulva or in the vagina; pain in the lower abdomen or pain or discomfort when passing water; any previous sexually transmitted disease or if the person’s partner has had an STD; if there is no improvement after using OTC thrush treatment.

3. The affected area is red and sore; sexual intercourse is painful.

4. A yeast called candida albicans. It usually lives harmlessly in the body, but can overgrow and cause thrush in certain conditions.

5. Tight or synthetic clothing and underwear; some medicines, including antibiotics; stress; hormonal changes during the menstrual cycle, pregnancy and the menopause; perfumed toiletries such as bath gel, etc; washing the vaginal area too vigorously; not bathing or showering and changing clothing after exercising.