Vaginal thrush (vulvovaginal candidiasis): symptoms, treatment and recurrence

Thrush is a common yeast infection that affects men and women. The NHS says it is not classed as a sexually transmitted infection, although it can be triggered by sex or, less often, passed on during sex. It is caused by a fungus called candida that normally lives harmlessly on the body and overgrows when the usual balance of bacteria is disturbed. Some people have no symptoms at all.

Because several conditions cause itching and discharge, thrush is worth confirming rather than assuming, especially the first time. NHS inform notes that thrush may have similar symptoms to some STIs, so it is important to seek advice if you might be at risk of one.

The NHS lists the symptoms in women as white vaginal discharge, often like cottage cheese, which does not usually smell; itching and irritation around the vulva and vagina; and soreness and stinging during sex or when you pee. In men, thrush shows as irritation, burning and redness around the head of the penis and under the foreskin, a white discharge and sometimes difficulty pulling back the foreskin. Thrush can also affect skin in the armpits, groin and between the fingers, as a red, itchy or painful rash that can be harder to see on darker skin.

The NHS notes thrush discharge does not usually smell, so a smelly discharge, or symptoms that do not fit this pattern, are a reason to be checked rather than self-treated.

NHS inform lists several factors that raise your chances. Some are medical, some are about products that irritate the skin, and some you cannot change. Noticing a pattern in your own episodes can help you and your clinician find a trigger.

• Taking antibiotics.

• Poorly controlled diabetes.

• A weakened immune system, for example from chemotherapy or HIV.

• Hormone replacement therapy, or pregnancy.

• Irritated or damaged skin, including from perfumed products, bubble baths or vaginal washing products.

The NHS recommends seeing a GP, or visiting a sexual health clinic, if you have thrush symptoms for the first time, if you are under 16 or over 60, if thrush 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 for example because of diabetes, HIV or chemotherapy.

At the appointment the clinician will want to confirm it is thrush and exclude other infections. If the cause is unclear or thrush keeps recurring, they may look at the area and wipe a cotton bud over the discharge to test for what is causing symptoms. NHS inform notes the test takes seconds and is not usually painful, though it can be uncomfortable for a moment, and that testing is also available in some pharmacies.

You usually need antifungal medicine: a tablet you swallow, a tablet inserted into the vagina (pessary) or a cream to relieve irritation, or a combination. The NHS says thrush should clear within 7 to 14 days of starting treatment. NHS inform stresses finishing the course even if symptoms ease earlier, and says untreated thrush eventually goes away by itself, so treatment is for those who have symptoms.

A pharmacist can supply antifungal treatment if thrush has been diagnosed before and you recognise the symptoms. The NHS says not to use antifungal medicine more than twice in 6 months without speaking to a pharmacist or doctor. Tell the clinician if you are pregnant, might be pregnant or are breastfeeding, because that can change the treatment offered. Antifungal creams can damage condoms and diaphragms, so contraception may not work if you have sex during treatment.

The NHS defines recurrent thrush as more than 4 episodes in 12 months. A GP can help identify whether something is causing it, such as your period or sex, and will recommend how often to use treatment, which may mean taking it for up to 6 months. NHS inform says a doctor or nurse will also check that other conditions such as diabetes are not the cause, and suggests that if you are prescribed an antibiotic for another condition you remind your doctor that you tend to get thrush and ask about preventive treatment.

Repeated self-treatment without testing can mask other conditions, so a recurrent pattern deserves a proper swab and review rather than another course from the pharmacy.

Both NHS sources give similar advice. Use water and a soap substitute (emollient) rather than soap, dry the area properly after washing, wear cotton underwear and avoid tight clothing. NHS inform adds avoiding bubble baths, essential oils, wet wipes, feminine washing products (even those labelled pH balanced), fabric softeners, and douching, which can damage the natural balance of healthy vaginal organisms. If sex is uncomfortable, avoid it until thrush has cleared, and use lubricant if you do have sex.

Partners do not need treatment unless they have symptoms. A private GP or sexual health clinic can offer swabs and review at short notice; the thing to ask for is a confirmed diagnosis, particularly when thrush recurs.