Recurrent thrush: why it keeps coming back and what helps

Thrush is caused by a fungus called candida, which is normally harmless. The NHS says it tends to grow in warm, moist conditions and develops if the balance of bacteria changes. It is usually harmless but can be uncomfortable and keep coming back. NHS inform describes it as a very common yeast infection.

Both the NHS and NHS inform use the same threshold: thrush that keeps coming back, meaning more than 4 times in 12 months, merits a GP appointment. Frequent episodes are worth discussing with a GP rather than treating each one as a standalone problem.

The NHS lists symptoms for women and men, and notes that thrush can sometimes cause no symptoms at all.

The NHS says to see a GP if you have symptoms of thrush for the first time, you have thrush and are under 16 or over 60, thrush keeps coming back (more than 4 times in 12 months), treatment has not worked, you are pregnant or breastfeeding, or you have a weakened immune system, for example because of diabetes, HIV or chemotherapy. NHS inform says you can contact your GP practice or a local sexual health clinic.

The NHS says the GP will want to confirm it is thrush and rule out other infections. If it is not clear it is thrush or it keeps coming back, a doctor or nurse may look at the vagina, penis or skin, and a cotton bud may be wiped over the discharge to check what is causing symptoms and to test for other infections. NHS inform adds that thrush may have similar symptoms to some STIs, so it is important to seek advice if you think you might be at risk.

The NHS says thrush can develop if your skin is irritated or damaged, you are taking antibiotics, you have poorly controlled diabetes, you have a weakened immune system (for example because of HIV or chemotherapy), you are having hormone replacement therapy (HRT) or you are pregnant. NHS inform adds the use of products that irritate the skin, such as perfumed products, bubble baths or vaginal washing products.

When thrush keeps returning, the NHS says a GP can help identify if something is causing it, such as your period or sex, and will recommend how often you should use treatment.

The NHS says you will usually need antifungal medicine, which can be a tablet you take, a tablet you insert into the vagina (pessary) or a cream to relieve the irritation. Thrush should clear up within 7 to 14 days of starting treatment. For recurrent thrush, you might need treatment for longer, up to 6 months, if you get it more than 4 times in 12 months. You should not use antifungal medicine more than twice in 6 months without speaking to a pharmacist or doctor.

NHS inform stresses taking the treatment as instructed and finishing the course even if symptoms go away earlier, and advises telling your doctor, nurse or pharmacist if you are pregnant, might be pregnant or are breastfeeding, as this may affect the type of treatment you are given. It also notes that some antifungal products can weaken latex condoms, diaphragms and caps.

The NHS suggests things you can do to ease discomfort and stop thrush coming back.

• Use water and an emollient (such as E45 cream) instead of soap to wash the affected area, and dry properly after washing.

• Wear cotton underwear and avoid tight underwear or tights.

• Avoid soaps, shower gels, douches and deodorants on the vagina or penis.

• Avoid sex until thrush has cleared up if sex is uncomfortable.

• Be aware that antifungal creams can damage condoms and diaphragms, so contraception might not work.

Thrush can be assessed by pharmacists, GP practices and sexual health clinics, and NHS inform says testing is available free from GP practices and sexual health services, and in some pharmacies. A private GP or gynaecology appointment may be quicker for recurrent episodes, but the investigation and treatment approach described above applies in either setting.