Hi, Good question Fiona.
- Barbara: yes, not all that burns or shoots is thrush
- Jack: yes,  sometimes it is breast pain only, and often follows
antibiotics and is not related to nipple trauma (however, thrush can occur
without antibiotics being administered).
- someone (sorry I can't find it now): yes, hopefully one day we will have
better testing
- Linda: yes some people have an allergy to candida, and sometimes allergy
to other things as well.
- Pat: yes, breastmilk does have many properties, but we can't expect it to
be completely effective against everything. Studies are needed on growth of
candida in breastmilk (there is someone working on this).
- Katherine C: yes, I'm amazed sometimes at the effect of diet - a heavy
dose of sugar or alcohol and the pain flares. When someone isn't improving
despite treatment and diet, sometimes it's worth going off the diet to see
what happens (perhaps it isn't thrush as Barbara said).
Regarding healthy people being able to recover from thrush: there are some
people who have reduced immune response to candida (see Witkin SS refs in
LC Series unit on Candidiasis). Dr Colin Little here in Melbourne has been
collecting blood samples to investigate cell mediated immunity in women
with recurrent thrush - I'll let you know when I hear any results. Also I
have mentioned before about my work at a vulval clinic - there are some
women (otherwise healthy) who respond to fluconazole, but need to take it
for a long time (months). Some of these women at the vulval clinic develop
a pain syndrome in addition to the thrush - they sometimes respond to low
dose tricylic antidepressants (eg amitriptyline)  - I have considered
trying this in a breastfeeding woman when the thrush should have responded,
but the pain continues, but haven't used it yet.
I hope this isn't too disjointed. I have too many things to do. Tomorrow I
become the mother of a teenager!
Lisa Amir
GP / IBCLC in Melbourne, Australia