Today, we’re speaking to Dr Tori Ford, a qualitative researcher based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. Title of papers: ‘Accumulative Experiences: Navigating Healthcare for Recurrent Vulvovaginal Thrush from Patient and Clinician Perspectives’ and ‘It’s not just thrush, it’s recurrent thrush’: Patient and Clinician Perspectives on Diagnosing Recurrent Vulvovaginal Candidiasis’. Available at: https://doi.org/10.3399/BJGP.2025.0437 and https://doi.org/10.3399/BJGP.2025.0531 Transcript This transcript was generated using AI and has not been reviewed for accuracy. Please be aware it may contain errors or omissions. Speaker A 00:00:01.280 - 00:01:15.200 Hi, and welcome to BJGP Interviews. I'm Nada Khan and I'm one of the associate editors of the journal. Thanks again for listening to this podcast today. In today's episode, we're speaking to Dr. Tori Ford, who is a qualitative researcher based at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. We're going to talk today about two linked papers that she and her team have published here in the bjgp. The first one is titled Accumulative Navigating Healthcare for Recurrent Vulvovaginal Thrush from Patient and Clinician Perspectives. And the second paper is it's not just thrush, it's recurrent thrush. Patient and Clinician Perspectives on Diagnosing Recurrent Vulva Vaginal Candidiasis. So, Tori, thanks very much for joining us here today. And this might come from a slightly unscientific perspective, but my feeling is that I'm seeing a lot more recurrent thrush in practice. And we know that it's incredibly common. I think, despite that, it's not something we hear discussed very often in primary care research. So my first question is, what made you want to study it? Speaker B 00:01:15.520 - 00:01:54.060 So, like you say, recurrent thrush is an increasingly common condition. We know that 1.2 million women in the UK live with it, 6% of people globally, and I just happen to have been one of them. So my paper came out of lived experience of living with recurrent thrush over many years and having a diagnostic journey of, you know, seeing different healthcare professionals looking for answers. And like you say, those feelings of shame and stigma that keep you feeling alone were all too familiar for me. So that's what actually led me into starting my PhD, looking at recurrent thrush and then wanting to hear other patient experiences as well. Speaker A 00:01:54.460 - 00:02:22.220 And we're looking at two of your papers here that were published in the bjgp, and they're both looking at the patient and the clinician perspective. And one thing that comes through really strongly in both papers is that recurrent thrush is often treated as if it's just repeated acute episodes rather than a condition in its own right. Why do you think that that distinction matters to patients and probably to clinicians as well, or should do? Speaker B 00:02:22.380 - 00:03:55.420 I think when we hear about thrush, it's often something that's seen as trivial or mundane, and that's often because it's through this lens of acute, transient, episodic, episod, and most of the time it is right. 75% Of people with Vaginas will have thrush at some point in their life. It's usually self managed over the counter with pharmacy care and symptoms resolved within a few days. But where recurrent thrush differs is when those symptoms keep coming back so that itching, burning pain and irritation becomes sometimes cyclical, sometimes repetitive. And I spoke to three or two patients who all had different durations of heat know, happening every two weeks, every month. And what they often found was because they were accessing fragmented care. So, you know, going to the pharmacy, sometimes going to the gp, sometimes maybe seeing sexual health, it was often seen as again, that mundane, one off, trivial case. And it was really hard to trace those patterns across care, especially due to a lack of continuity. Right. If you're trying to track a pattern but nobody is following you up, it's really difficult to, to capture those. So I think it's a few layers of one. I explore how these sort of social dimensions keep it seen as something maybe less long term, but then also in the ways that sort of care was fragmented made it harder for those patterns to be picked up and then to transition the care moving away from, you know, acute one off prescriptions of an antifungal medication to something that required repeat, repetitive, enduring, you know, testing, treatment, retesting of treatments. Speaker A 00:03:56.060 - 00:04:09.970 Absolutely. And I think what's interesting is that your papers describe recurrent thrush as something that's accumulative and cyclical over time. And you mentioned that it's not just these sort of one off episodes. Can you explain what patients meant by that? Speaker B 00:04:10.210 - 00:05:13.850 Yeah. So often, I think when we talk about healthcare, journeys are presented in a way that's quite linear and straightforward that, you know, you see a healthcare professional, you get treatment, you go home, you start to feel better. But with recurrence, something interesting happens where people aren't, you know, returning to the start. It's not that you go back to a blank page and then restart your healthcare journey every time you're carrying with you everything, everything that's amassed through healthcare encounters, what you've seen online, what you discuss with friends, and that is all carrying through to those consultations. And I think what was really important there was acknowledging that for many people there was a lot to unpack there and often they felt that it wasn't being acknowledged in those clinical spaces. It was seen as, oh, it's just thrush. And that's why in one of the papers the title is, it's not just thrush, it's recurrent thrush. And that's a quote from One of the participants who was speaking about the importance of labeling and distinguishing this condition, especially in terms of the impacts it had on people's lives and also the approaches and pathways that would be needed to properly treat it. Speaker A 00:05:14.330 - 00:05:32.570 And this is an issue that we see across clinical care and women's healthcare. But a lot of participants described feeling dismissed or not listened to. And I wanted to just get your perspective from your wider sort of work in this area is how much of that reflected wider issues in women's health care, do you think? Speaker B 00:05:33.170 - 00:06:46.980 Yeah, I mean, we know there's increasing conversations, right, with the women's health strategy, with the Cumberlage report, about how people's pain is often dismissed based on their gender. And that definitely came across in the studies. But I think what was interesting was that both patients and clinicians were aware of this. And something that is quite interesting was in the diagnostic paper, we look at sort of those moments where there were sort of miscommunication or differing expectations between patients and clinicians, clinicians, where clinicians were, you know, operating on a standard guideline that requires two swabs, two positive swabs for a thrush within a year to diagnose recurrent thrush. But when that wasn't communicated to the patient, of being told we need to accumulate these number of swabs, what the patients thought was happening was, oh, they're swabbing me again, they're not listening to me, they don't believe me. So it was interesting where the dismissal was often in those moments of, you know, it wasn't healthcare professionals saying, this isn't important, or please don't come see me about this. It was really in those sort of small details where patients were operating on one framework and clinicians on another. And there were these gaps in communication. And that's why our papers seek to address some of those gaps with some recommendations as well. Speaker A 00:06:47.620 - 00:07:04.640 Yeah, and as you mentioned, one of the papers is called it's not just thrush, it's recurrent thrush. And I wonder what you felt were the key challenges around actually recognizing recurrence in primary care, as opposed to it just being a, a one off episode. Speaker B 00:07:04.720 - 00:09:30.220 There's multiple layers to this, I think, in terms of the. The papers are sort of split in terms of the diagnostic journey and then the healthcare journey. But that's sort of an artificial split in some ways, because what we saw a lot was, you know, patients trying to seek out continuity of care to get someone to notice the pattern that they were starting to see and assign a label to it and we saw some hesitancy with this in clinicians who said, you know, I'm not going to use the term recurrence because that sounds like it's something serious or sounds like it's chronic. And they saw that being helpful. But then for patients they found that really challenging because they said, you know, they just see it as thrush, they just see it as a one off case, they're not recognizing it when often...
