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Vaginal Thrush
Many women have an occasional bout of vaginal thrush. It is due to an infection with
a yeast fungus called Candida spp. Treatment options include a tablet that you can
take by mouth, or anti-thrush pessaries that you can insert into the vagina. There is
also anti-thrush cream that you can rub on to the skin around the vagina (the vulva)
if needed. Treatment usually works well. However, some women have recurring
bouts of thrush which may need longer courses of treatment.

What is thrush?
Thrush is an infection caused by a yeast fungus called Candida spp. Small numbers of
Candida spp. commonly live on the skin and around the vaginal area. These are usually
harmless. The immune system and the harmless bacteria that also normally live on the skin
and in the vagina usually stop Candida spp. from thriving. However, when conditions are
good for Candida spp., numbers multiply and may invade the vagina and cause symptoms.

The conditions most liked by Candida spp. are warm, moist, airless parts of the body. This
is why the vagina is the most common site for candidal infection. Other areas of the body
that are prone to candidal infection include the groin, the mouth, and the nappy area in
babies.

Most causes of thrush are a result of Candida albicans but sometimes other types of
Candida spp., such as Candida glabrata or Candida tropicalis, are the cause.

What are the symptoms of vaginal thrush?

Thrush is the second most common cause of a vaginal discharge. (The most common
cause of vaginal discharge is bacterial vaginosis. A separate leaflet called 'Bacterial
Vaginosis' gives more details.)

The discharge from thrush is usually creamy white and quite thick, but is sometimes watery.
It can cause itch, redness, discomfort, or pain around the outside of the vagina (the vulva).
The discharge from thrush does not usually smell. Some women can have some pain or
discomfort whilst having sex or whilst passing urine if they have thrush.

Sometimes symptoms are minor and clear up on their own. Often symptoms can be quite
irritating and will not go without treatment.

Thrush does not damage the vagina, and it does not spread to damage the uterus (womb).
If you are pregnant, thrush will not harm your baby.

Who gets vaginal thrush?

More than half of all women will have at least one bout of thrush in their life. In most cases it
develops for no apparent reason. However, certain factors can make thrush more likely to
develop. The vagina contains mucus and some harmless bacteria which help to defend the
vagina from candidal infection (and other germs). These natural defences may be altered or
upset by certain situations - for example, when you are pregnant, if you have diabetes or if
you take antibiotics. So, in these situations, you may be more likely to develop thrush.

People with a poor immune system are also more likely to get thrush - for example, people
on chemotherapy for certain cancers, people taking high-dose steroids, etc.
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Do I need any tests?

You do not always need a test to diagnose thrush. The diagnosis is often based on the
typical symptoms and signs. However, it is important that you do not assume that a vaginal
discharge is thrush. There are other causes of vaginal discharge. If you have never had
thrush before, then see a doctor or nurse to confirm the diagnosis and for advice on
treatment. The doctor or nurse may examine you. No tests may be necessary if the
symptoms and signs are typical. However, the doctor or nurse may take small samples of
the discharge with swabs if the cause of the discharge is not clear. The swabs are then sent
to the laboratory to confirm the cause of the discharge.

What are the treatment options for vaginal thrush?

Topical thrush treatment
These are pessaries and creams which you insert into the vagina with an applicator. They
contain anti-yeast medicines such as clotrimazole, econazole or miconazole. Commonly, a
single large dose inserted into the vagina is sufficient to clear a bout of thrush. However,
you may also want to rub some anti-thrush cream on to the skin around the vagina (the
vulva) for a few days, especially if it is itchy. You can get topical treatments on prescription,
or you can buy them at pharmacies without a prescription. Side-effects are uncommon, but
read the information leaflet that comes with the treatment for full information.

In general, you can use these topical treatments if you are pregnant but you should always
check with your doctor or pharmacist. Treatment may be needed for longer during
pregnancy.

Note: some pessaries and creams may damage latex condoms and diaphragms and affect
their use as a contraceptive.
Tablets
Two options are available. Fluconazole, which is taken as a single dose, or itraconazole
which is taken as two doses over the course of one day. You can get these treatments on
prescription, and you can also buy fluconazole without a prescription from pharmacies.
Side-effects are uncommon, but always read the information leaflet that comes with the
treatment for full information. Do not take these treatments if you are pregnant or breast-
feeding. You may also want to rub some anti-yeast cream on to the skin around the vagina
for a few days, especially if it is itchy.

Note: tablets and topical treatments are thought to be equally effective. Tablets are more
convenient, but are more expensive than most topical treatments.
Other things that may help
If you have thrush, you may also find the following things help to relieve your symptoms:
Avoiding wearing tight-fitting clothing, especially clothing made from synthetic
materials. Loose-fitting, natural fibre underwear may be better.
Avoiding using perfumed products around the vaginal area, such as soaps and
shower gels, as these may cause further irritation.

What if the treatment does not work?

If you still have symptoms a week after starting treatment, then see your doctor or nurse.
Treatment does not clear symptoms in up to 1 in 5 cases. Reasons why treatment may fail
include:
The symptoms may not be due to thrush. There are other causes of a vaginal
discharge. Also, thrush can occur at the same time as another infection. You may
need tests such as vaginal swabs to clarify the cause of the symptoms.
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Most bouts of thrush are caused by Candida albicans. However, about 1 in 10 bouts
of thrush is caused by other strains of Candida spp., such as Candida glabrata.
These may not be so easily treated with the usual anti-thrush medicines.
You may not have used the treatment correctly.
You may have had a quick recurrence of a new thrush infection. (This is more likely if
you are taking antibiotics, or if you have undiagnosed or poorly controlled diabetes.)

Some other points about vaginal thrush

'Natural' remedies for thrush include: live yoghurt inserted into the vagina; adding
vinegar or bicarbonate of soda to a bath to alter the acidity of the vagina; tampons
impregnated with tea tree oil. However, at present there is little scientific evidence to
show that these remedies work but some women may find that they help soothe their
symptoms.
Thrush is not a sexually transmitted infection. Candida spp. is a yeast germ which
commonly occurs on the skin and vagina. For reasons not quite clear, it sometimes
multiplies to cause symptoms.
Male sexual partners do not need treatment unless they have symptoms of thrush on
their penis. Symptoms in men include redness, itch, and soreness of the foreskin and
the head (glans) of the penis. Women do not catch thrush from men who have no
symptoms.
Thrush occurs more commonly in pregnant women, and can be more difficult to
clear. It can take several days of topical treatment to clear thrush if you are pregnant.
Some women develop recurring thrush. This is defined as having an episode of
thrush four or more times in a year. If this occurs, see your doctor for advice on
preventative treatment. (See also the separate leaflet called 'Thrush - Recurring
Vaginal'.)

Do I need to see a doctor if I get vaginal thrush?

If you have had thrush in the past and the same symptoms recur, then it is common practice
to treat it without an examination or tests. Many women know when they have thrush and
treat it themselves. You can buy effective treatments (discussed above) without a
prescription from pharmacies.

However, remember, a vaginal discharge or vulval itch can be due to a number of causes.
So, do not assume all discharges or itch are thrush. The following gives a guide as to when
it may be best to see a doctor or nurse if you think that you might have thrush. If you:
Are under 16 or over 60 years of age.
Are pregnant.
Have abnormal vaginal bleeding.
Have lower abdominal pain.
Are unwell in yourself in addition to the vaginal and vulval symptoms.
Have symptoms that are not entirely the same as a previous bout of thrush. For
example, if the discharge has a bad smell, or it you develop ulcers or blisters next to
your vagina.
Have had two episodes of thrush in six months, and have not consulted a doctor or
nurse about this for more than a year.
Have had a previous sexually transmitted infection (or your partner has).
Have had a previous bad reaction to anti-thrush medication or treatments.
Have a weakened immune system - for example, if you are on chemotherapy
treatment for cancer or are taking long-term steroid medication for whatever reason.

And if you do treat yourself, see a doctor or nurse if the symptoms do not clear with
treatment.
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References
Management of vulvovaginal candidiasis, British Association for Sexual Health and
HIV (2007)
Abad CL, Safdar N; The role of lactobacillus probiotics in the treatment or prevention
of urogenital J Chemother. 2009 Jun;21(3):243-52. [abstract]
Nurbhai M, Grimshaw J, Watson M, et al; Oral versus intra-vaginal imidazole and
triazole anti-fungal treatment of Cochrane Database Syst Rev. 2007 Oct 17;
(4):CD002845. [abstract]
Spence D, Melville C; Vaginal discharge. BMJ. 2007 Dec 1;335(7630):1147-51.
Sobel JD; Vulvovaginal candidosis. Lancet. 2007 Jun 9;369(9577):1961-71.
[abstract]
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions.
EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or
other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

The clinicians responsible for the production of this document are:

Original Author: Dr Tim Kenny Current Version: Dr Michelle Wright Peer Reviewer: Dr Tim Kenny
Last Checked: 3 Jun 2011 Document ID: 4350 Version: 41 EMIS