Thrush
Thrush affects 75% of women. Compare fluconazole vs clotrimazole and understand recurrent thrush management.
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Thrush (Candidiasis)
Causes, symptoms, diagnosis and UK treatment options for vaginal thrush, oral thrush and recurrent candidiasis — and how to tell thrush apart from the conditions it is most often confused with.
Part of the Access Doctor Conditions Library.
Key fact: Thrush is caused by Candida fungus — most commonly Candida albicans — and affects approximately 75% of women at least once in their lifetime. It is not a sexually transmitted infection and not caused by poor hygiene. It is highly treatable with antifungal medicines. The single most useful thing to establish first is whether it actually is thrush: itching with thick, odourless white discharge points to thrush, while a fishy smell, an internal burning on passing urine, or itching after the menopause all point elsewhere.
What Is Thrush?
Thrush is a common infection caused by overgrowth of Candida fungi, most frequently Candida albicans. Candida is normally present in small amounts in the vagina, mouth, skin and gut, kept in check by the body’s immune system and the balance of healthy bacteria. When this balance is disrupted, Candida can proliferate and cause symptomatic infection.
Vaginal thrush (vulvovaginal candidiasis) is the most common form in women of reproductive age. Oral thrush (oropharyngeal candidiasis) is common in infants, the elderly, immunocompromised individuals, and those using inhaled corticosteroids. Thrush is not a sexually transmitted infection, though it can occasionally be passed between sexual partners.
Types of Thrush
| Type | Site Affected | Who It Affects Most | Key Features |
|---|---|---|---|
| Vaginal thrush (vulvovaginal candidiasis) | Vagina and vulva | Women of reproductive age; most common in 20s–30s | Intense itching; thick white discharge; vulval soreness; not sexually transmitted |
| Oral thrush (oropharyngeal candidiasis) | Mouth, tongue, throat | Infants; elderly; inhaled steroid users; immunocompromised | White patches on tongue and cheeks; sore mouth; difficulty swallowing — see our oral thrush guide |
| Penile thrush (candidal balanitis) | Glans penis and foreskin | Uncircumcised men; men with diabetes | Redness, itching and soreness of the glans; white discharge under the foreskin — see our thrush in men guide |
| Cutaneous candidiasis | Skin folds (groin, under breasts, armpits) | People with diabetes or obesity; those in moist environments | Red, itchy, moist rash with satellite lesions at the fold margins |
| Recurrent vulvovaginal candidiasis | Vagina and vulva | 5–8% of women; genetic susceptibility plays a part | Four or more confirmed episodes in 12 months; needs maintenance therapy |
Causes and Risk Factors
Thrush develops when conditions favour Candida overgrowth. The most important risk factors are:
Antibiotic use
The most common precipitating factor for vaginal thrush. Broad-spectrum antibiotics reduce the protective Lactobacillus population, allowing Candida to proliferate. Thrush often begins during or shortly after a course of antibiotics, a pattern we cover in thrush after antibiotics.
Diabetes mellitus
Elevated blood glucose provides a rich growth substrate for Candida. Recurrent or treatment-resistant thrush in someone not known to have diabetes should prompt blood glucose testing. SGLT2 inhibitor medicines, which excrete glucose in the urine, carry the same risk — see thrush and diabetes.
Hormonal changes
Oestrogen promotes glycogen deposition in vaginal cells, which Candida metabolises. Thrush is more common in the second half of the menstrual cycle and during pregnancy, particularly the third trimester.
Immunosuppression
HIV infection, chemotherapy, high-dose systemic corticosteroids and other immunosuppressive therapies increase susceptibility at all sites. Severe or recurrent thrush in a previously healthy person warrants review.
Inhaled corticosteroids
A specific risk for oral thrush. Steroid residue deposits in the mouth and suppresses local immunity. Rinsing and gargling with water after every inhaler dose substantially reduces the risk, and oral thrush covers the rest of the picture.
Local irritants
Soaps, shower gels, bubble baths, intimate washes and douching disturb the vulval skin and the vaginal environment. Prolonged damp clothing and tight synthetic fabrics contribute, though less than the factors above.
Symptoms
Vaginal thrush
- Intense itching and irritation of the vulva and vagina — often the most distressing symptom
- Thick, white, creamy or cottage-cheese-like discharge, typically without significant odour
- Soreness and redness of the vulva; swelling of the labia in severe cases
- Stinging or burning when urinating, as urine passes over inflamed vulval skin
- Pain or discomfort during sex
- Cracked or fissured vulval skin in severe or recurrent cases
Oral thrush
- White or creamy patches on the tongue, inner cheeks, roof of the mouth or throat
- Patches that bleed if scraped or rubbed
- Soreness and loss of taste
- Difficulty swallowing in severe cases, particularly in immunocompromised people
- Cracking at the corners of the mouth (angular cheilitis)
Symptoms in men differ and are covered separately in our guide to thrush in men, and the mouth has its own pattern of white patches, altered taste and denture-related soreness set out in oral thrush.
Thrush vs Bacterial Vaginosis: Key Differences
Thrush and bacterial vaginosis are the two most common causes of abnormal vaginal discharge, and they need completely different treatments.
| Feature | Vaginal Thrush | Bacterial Vaginosis |
|---|---|---|
| Cause | Candida fungal overgrowth | Bacterial imbalance — fewer Lactobacilli, overgrowth of anaerobes |
| Discharge | Thick, white, cottage-cheese texture; no odour | Thin, watery, grey-white; fishy odour |
| Itching | Intense itching — the hallmark symptom | Usually absent or mild |
| Odour | None | Characteristic fishy smell, worse after sex |
| Vaginal pH | Normal (<4.5) | Elevated (>4.5) |
| Treatment | Antifungals: fluconazole or clotrimazole | Antibiotics: metronidazole or clindamycin |
Important: antifungal treatment will not work if the diagnosis is actually bacterial vaginosis, and vice versa. If you are unsure, or have never been diagnosed with thrush before, get assessed before treating. A vaginal pH self-test measures the one thing that reliably separates the two — see our guide to using one and our guide to bacterial vaginosis.
Is It Thrush, or Something Else?
Bacterial vaginosis is the most common alternative, but it is not the only one. Vulval itching and discharge have a wider differential than most people realise, and repeated courses of antifungals are the usual consequence of getting it wrong. For the three infections that account for most cases, our side-by-side comparison of thrush, BV and trichomoniasis sets out discharge, smell, itching, pH and the different treatment each needs.
| Condition | What points to it instead of thrush |
|---|---|
| Bacterial vaginosis | Thin grey discharge with a fishy smell, worse after sex; itching usually absent — see our BV page |
| Trichomoniasis | Frothy yellow-green discharge, soreness and an unpleasant smell; a sexually transmitted infection needing testing and partner treatment |
| Cystitis or urine infection | Burning felt internally rather than on the vulva, urgency and frequency, passing small amounts, cloudy urine — see our cystitis page |
| Genital herpes | Painful blisters or ulcers rather than diffuse itching; tingling before an outbreak |
| Vulval eczema or contact dermatitis | Itching with dry, scaly or sore skin and no abnormal discharge; often traceable to soaps, wipes, pads or washing products |
| Lichen sclerosus | Persistent itching with white, thickened or shiny skin and no response to antifungals; needs specialist assessment |
| Atrophic vaginitis | Itching, dryness and pain during sex after the menopause, without discharge — see our HRT page |
| Chlamydia or gonorrhoea | Change in discharge with pelvic pain, bleeding between periods, or a recent new partner — needs sexual health testing |
The practical rule: thrush itches and produces thick, odourless discharge. If there is no itch, if there is a smell, if the burning is internal rather than external, if there are ulcers or bleeding, or if antifungals have already failed once, the working diagnosis should change rather than the brand of antifungal.
Diagnosis
In a woman with typical symptoms who has been diagnosed with thrush before, self-diagnosis and treatment is reasonable. NICE recommends clinical assessment in several situations, set out in when to seek help below.
Clinical diagnosis rests on history and examination, supported by vaginal pH where the distinction from bacterial vaginosis is unclear. In recurrent or treatment-resistant cases a high vaginal swab for Candida culture allows species identification and sensitivity testing — important because non-albicans species, particularly C. glabrata and C. krusei, may not respond to fluconazole.
Treatment Options
| Treatment | Form | Dosing | Notes |
|---|---|---|---|
| Fluconazole 150mg | Oral capsule | Single dose | Around 80–90% cure at 7 days; not recommended in pregnancy; also used for penile thrush |
| Clotrimazole pessary 500mg | Intravaginal pessary | Single dose at bedtime | Equivalent efficacy; preferred in pregnancy; minimal absorption; damages latex condoms |
| Clotrimazole cream 2% | Topical cream | Applied to the vulva 2–3 times daily for up to 7 days | Treats vulval symptoms; used alongside a pessary where both vulva and vagina are involved |
| Clotrimazole pessary 100mg | Intravaginal pessary | One nightly for 6 nights | Longer course; useful where extended local treatment is preferred |
| Fluconazole maintenance | Oral capsule | 150mg weekly for 6 months after induction | For recurrent thrush; prevents recurrence in around 90% during treatment; needs a prescriber’s oversight |
| Nystatin or miconazole | Oral suspension or gel | Four times daily for 7–14 days | For oral thrush; acts locally with little systemic absorption. Miconazole gel interacts with warfarin |
How the two main options compare in practice — speed, interactions, and which suits which circumstances — is covered in fluconazole vs Canesten.
Pregnancy: oral fluconazole is not recommended during pregnancy. Intravaginal clotrimazole is the preferred treatment, usually over a longer course. Always tell your prescriber if you are pregnant or trying to conceive — see thrush in pregnancy.
Condoms and diaphragms: antifungal creams and pessaries damage latex and can cause condoms and diaphragms to fail. Use another form of contraception during treatment and for at least five days afterwards.
How Long Thrush Takes to Clear
Itching usually starts to ease within one to three days of treatment, and symptoms are generally gone within a week. Discharge tends to settle before soreness and redness do, so mild residual tenderness after the discharge has resolved is normal rather than a sign of failure.
If there has been no clear improvement after seven days of correct treatment, the most likely explanation is that this is not thrush — work through thrush vs BV vs trichomoniasis before buying anything else. The second most likely is a non-albicans species that does not respond to fluconazole. Either way, the next step is assessment and ideally a swab rather than another course of the same medicine.
Recurrent Thrush
Recurrent vulvovaginal candidiasis is defined as four or more symptomatic, confirmed episodes within 12 months. It causes considerable distress and needs a structured approach rather than repeated single doses.
- Confirm the diagnosis with a high vaginal swab — culture identifies the species and its sensitivity
- Induction: fluconazole 150mg every 72 hours for three doses
- Maintenance: fluconazole 150mg once weekly for six months, preventing recurrence in around 90% of women during treatment
- Screen for contributors: blood glucose or HbA1c, iron deficiency, and HIV testing where clinically appropriate
- Address what can be changed: unnecessary antibiotics, high-oestrogen contraception, glycaemic control, and local irritants
Non-albicans thrush: around 10% of recurrent cases are caused by non-albicans species that do not respond to fluconazole. Candida glabrata in particular needs specialist treatment. Culture is essential in anyone not responding to standard treatment. Our recurrent thrush guide covers the full six-month approach, including what happens after it ends.
Thrush After the Menopause
Thrush is less common after the menopause than before it, because falling oestrogen reduces the glycogen that Candida feeds on. That makes persistent itching in this age group more likely to be something else — and it is frequently treated as thrush for months before the real cause is identified.
The three conditions worth knowing about are atrophic vaginitis, where thinning dry tissue causes itching, soreness and pain during sex without infection; vulval eczema or contact dermatitis from soaps and washing products; and lichen sclerosus, which produces white, thickened skin and needs specialist assessment because it carries a small long-term risk of vulval cancer.
Worth acting on: NICE advises clinical assessment for anyone over 60 with suspected thrush, and any post-menopausal bleeding, vulval lump, ulcer or persistent white patch needs prompt review rather than another antifungal. Our HRT page covers the menopausal picture more fully.
Thrush, Sex and Partners
Thrush is not classified as a sexually transmitted infection. The yeast responsible already lives in the body, and infection reflects a change in local conditions rather than transmission. It can occasionally pass between partners during sex, but that is not how most episodes arise.
Routine treatment of a partner who has no symptoms is not recommended and has not been shown to reduce recurrence. A partner with symptoms should be treated in their own right — see thrush in men. Sex is best avoided while symptomatic, mainly because it is uncomfortable and aggravates inflamed tissue, and because antifungal creams compromise latex contraception for several days.
If symptoms follow every new partner or every episode of sex, that pattern deserves a sexual health check rather than an assumption of thrush. Chlamydia, gonorrhoea, trichomoniasis and herpes all cause genital symptoms that can be mistaken for it.
Thrush in Babies and Children
Oral thrush is common in babies, appearing as white patches inside the mouth that do not wipe away easily, sometimes with reluctance to feed. It is treated with a topical antifungal gel or suspension prescribed for the child’s age, and it is not dangerous.
In breastfed babies, thrush frequently passes between baby and nipple, causing nipple pain alongside the baby’s oral symptoms. Both need treating at the same time for either to clear, which is a conversation for your midwife, health visitor or GP. Candida can also complicate nappy rash, producing a red rash with small satellite spots that persists despite barrier cream. Any suspected thrush in a baby or child should be assessed rather than self-treated.
Prevention
- Wash with water or an unperfumed emollient rather than soap, shower gel, bubble bath or intimate washes
- Avoid vaginal douching entirely — it disrupts the natural vaginal environment
- Wear loose-fitting cotton underwear; change out of wet swimwear or sports clothing promptly
- Rinse your mouth and gargle with water after every dose of an inhaled corticosteroid
- Optimise blood glucose control if you have diabetes
- Wipe front to back, and avoid scented wipes, pads and fabric softeners
- During antibiotic courses, a probiotic may help, though the evidence is modest
When to Seek Help
Seek clinical assessment if:
- You have never been diagnosed with thrush before — symptoms may have another cause
- You are pregnant or breastfeeding — treatment differs
- You are under 16 or over 60
- Symptoms have not improved after completing a course of treatment
- You have had four or more episodes in the past 12 months
- You have symptoms that could suggest a sexually transmitted infection, or a recent new partner
- You have abdominal or pelvic pain, fever, unusual bleeding, ulcers or sores — these are not thrush
- Itching persists after the menopause despite antifungal treatment
Seek urgent medical attention if you develop a high fever, shivering, severe abdominal pain or signs of systemic illness alongside genital symptoms. These are not features of uncomplicated thrush and may indicate a serious pelvic infection.
Where to go next
A first episode, a treatment that has not worked, symptoms in pregnancy, or a fourth episode in a year all belong with a clinician rather than a repeat purchase. Access Doctor is a GPhC-registered pharmacy and our pharmacist independent prescribers can assess you online — the thrush treatment page explains how that works and what is available.
Thrush at Access Doctor →All Thrush Guides
Eight in-depth guides across the thrush topic. Start with choosing between fluconazole and Canesten if you are treating an episode now, the discharge comparison if you are not sure it is thrush, recurrent thrush if this is the fourth episode this year, or oral thrush if the problem is in your mouth. Specific situations have their own guides: pregnancy, men, after a course of antibiotics and diabetes. The bacterial vaginosis guides below cover the condition most often mistaken for thrush.
Frequently Asked Questions
What is thrush?
Thrush is a common fungal infection caused by Candida species — most commonly Candida albicans. It can affect the vagina, penis, mouth and skin folds. Vaginal thrush affects approximately 75% of women at least once in their lifetime. It is not a sexually transmitted infection and it is not caused by poor hygiene, though it can occasionally be passed between partners during sex.
What are the symptoms of vaginal thrush?
The main symptoms are intense itching and irritation around the vagina and vulva, a thick white cottage-cheese-like discharge without significant odour, soreness and redness of the vulva, pain during sex, and stinging when urinating. Thrush does not typically cause a fishy odour — that is more characteristic of bacterial vaginosis.
What is the difference between thrush and bacterial vaginosis?
Thrush causes intense itching, thick white odourless discharge and vulval soreness, driven by fungal overgrowth. Bacterial vaginosis causes thin grey-white watery discharge with a characteristic fishy odour, but usually without significant itching. They require completely different treatments: antifungals for thrush, antibiotics for BV. Getting the diagnosis right matters.
What treatments are available for thrush?
Thrush is treated with antifungal medicines. Vaginal thrush is commonly treated with a single-dose fluconazole 150mg capsule taken orally, or with intravaginal clotrimazole pessaries and cream. Both are similarly effective, with cure rates of around 80 to 90% at seven days. Oral fluconazole is not recommended in pregnancy, where intravaginal clotrimazole is preferred.
How long does thrush take to clear up?
Itching usually begins to ease within one to three days of starting treatment, and symptoms are generally gone within a week. Soreness and vulval redness can take a little longer to settle than the discharge does. If symptoms have not clearly improved after seven days of correct treatment, the likeliest explanation is that the diagnosis is wrong rather than that the medicine has failed, and it is worth being assessed.
Is it thrush or a urine infection?
Both can cause stinging when you pass urine, which is why they are confused. In thrush the stinging happens as urine passes over inflamed vulval skin on the outside, and the dominant symptoms are itching and thick white discharge. In a urine infection the pain is felt internally, usually with a frequent urgent need to pass urine, passing only small amounts, and sometimes cloudy or strong-smelling urine and lower abdominal discomfort. Thrush does not cause fever or back pain.
Can you pass thrush to a partner?
Thrush is not classified as a sexually transmitted infection, but it can occasionally be passed between partners during sex. Routine treatment of a partner without symptoms is not recommended and has not been shown to reduce recurrence. A partner who does have symptoms — itching, redness or soreness of the penis, or a white discharge under the foreskin — should be treated in their own right.
What is recurrent thrush and how is it treated?
Recurrent vulvovaginal candidiasis is defined as four or more symptomatic, confirmed episodes within 12 months, and it affects around 5 to 8% of women. Treatment involves induction with fluconazole 150mg every 72 hours for three doses, followed by maintenance with fluconazole 150mg weekly for six months, which prevents recurrence in around 90% of women during treatment. A swab to confirm the species is recommended before starting maintenance.
Could itching after the menopause be something other than thrush?
Frequently, yes. After the menopause, falling oestrogen thins and dries the vaginal and vulval tissue, producing itching, soreness and pain during sex without any infection at all. Vulval skin conditions such as lichen sclerosus and eczema also become more common with age. Thrush is less common after the menopause than before it, so persistent itching in this age group should be assessed rather than treated repeatedly with antifungals.
References
- National Institute for Health and Care Excellence (NICE). Candida — female genital: Clinical Knowledge Summary. cks.nice.org.uk/topics/candida-female-genital
- NHS. Thrush in men and women. nhs.uk/conditions/thrush-in-men-and-women
- NHS. Fluconazole. nhs.uk/medicines/fluconazole
- Sobel JD. Recurrent vulvovaginal candidiasis. American Journal of Obstetrics and Gynecology. 2016;214(1):15–21.
- British Association for Sexual Health and HIV (BASHH). UK National Guideline for the Management of Vulvovaginal Candidiasis. bashh.org/guidelines
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Vulval and vaginal symptoms have several possible causes and thrush is only one of them. Always consult a qualified healthcare professional for diagnosis and treatment. In a medical emergency, call 999.
