Genital herpes vs thrush: how the symptoms differ

Itching, soreness and stinging in the genital area send many people to search for an explanation, and herpes and thrush are two of the most common. They have little in common biologically. The NHS describes genital herpes as a sexually transmitted infection passed on through vaginal, anal and oral sex, caused by the herpes simplex virus. Thrush, it says, is a common yeast infection that affects men and women, is usually harmless although uncomfortable, and is not classed as an STI.

Because the symptoms of both can include itching, irritation and pain when passing urine, it is hard to be certain from symptoms alone, and the NHS recommends a clinical check at first presentation of either.

The table summarises the NHS descriptions of each condition.

The NHS says symptoms of genital herpes include small blisters that burst to leave red, open sores around the genitals, anus, thighs or bottom, tingling, burning or itching around the genitals, pain when you pee, and discharge that is not usual for you. Symptoms might not appear for weeks or even years after infection, so the NHS advises going to a sexual health clinic even if you have not had sex for a long time.

A doctor or nurse at a sexual health clinic will ask about symptoms and sexual partners and take fluid from a blister or sore with a small cotton bud swab. The NHS says the test cannot be done if you do not have visible blisters or sores, and cannot tell you how long you have had herpes or who you got it from.

There is no cure. Symptoms clear up on their own, but blisters can come back, usually milder than the first episode. The NHS says antiviral medicine taken within 5 days of symptoms appearing may be prescribed for a first episode, and that it may shorten an outbreak by 1 or 2 days if started as soon as symptoms appear in a recurrence. Some people who have more than 6 outbreaks in a year may benefit from taking antiviral medicine for 6 to 12 months.

Herpes is very easy to pass on from the first tingling or itching of an outbreak until the sores have fully healed, and may be passed on even without symptoms. The NHS advises avoiding vaginal, anal and oral sex until sores have gone, using condoms, and not sharing sex toys.

The NHS lists thrush symptoms in women as white vaginal discharge (often like cottage cheese) that does not usually smell, itching and irritation around the vulva and vagina, and soreness and stinging during sex or when you pee. In men they are irritation, burning and redness around the head of the penis and under the foreskin, a white discharge like cottage cheese, an unpleasant smell and difficulty pulling back the foreskin. It can also affect skin such as the armpits, groin and between the fingers, causing a red, itchy or painful rash, and sometimes causes no symptoms at all.

Thrush develops when the balance of bacteria changes. The NHS lists skin irritation or damage, antibiotics, poorly controlled diabetes, a weakened immune system, hormone replacement therapy and pregnancy as possible reasons. Treatment is antifungal medicine as a tablet, a pessary inserted into the vagina, or a cream. The NHS says partners do not need treatment unless they have symptoms, and that antifungal creams can damage condoms and diaphragms, so contraception might not work during treatment.

You can buy antifungal medicine from pharmacies if thrush has been diagnosed before and you know the symptoms, but the NHS says not to use it more than twice in 6 months without speaking to a pharmacist or doctor. See a GP if it is the first time, if you are under 16 or over 60, if it keeps coming back (more than 4 times in 12 months), if treatment has not worked, if you are pregnant or breastfeeding, or if you have a weakened immune system.

No set of symptoms is a guarantee, but the NHS descriptions suggest a rough guide. Open sores or blisters, especially in a cluster or that recur in the same place, with tingling beforehand, are more typical of herpes. A thick, white, cottage-cheese-like discharge with itching but no sores is more typical of thrush. Symptoms that include both, or that do not match either picture, need examination.

If you are not sure, the NHS gives a practical route. For possible genital herpes, go to a sexual health clinic as soon as possible; many offer a walk-in service and often get test results quicker than GP practices. The NHS says you can see a GP but they will probably refer you to a sexual health clinic. For first-time thrush symptoms, see a GP or you may be able to get help from a sexual health clinic. Avoid sex while symptoms are present and do not use creams on unexplained sores before you know what they are.

A diagnosis of genital herpes can be distressing. The NHS says that outbreaks tend to become less frequent and less severe over time, that some people never have outbreaks, and that the risk of passing on the virus is higher in the first 6 months of infection and rare after 2 years.