Vaginal thrush: symptoms, treatment and why it keeps coming back
In 30 seconds
Thrush is one of the most common reasons women notice a change in their discharge. About 3 in 4 women have it at least once, and 40–45% have it two or more times1. It is usually harmless, but it can be very uncomfortable.
What causes thrush
Thrush is caused by a yeast (fungus) called candida. Small amounts normally live in the vagina without causing problems. Thrush happens when it grows too much2,3.
It is more likely if you2:
- are taking antibiotics
- are pregnant
- have diabetes that is not well controlled
- have a weakened immune system
- are having hormone replacement therapy (HRT)
- have irritated or damaged skin
Thrush is not classed as an STI. Sex can trigger it, and less often it can be passed on during sex2.
Symptoms of thrush
Typical symptoms in women are2:
- white discharge, often like cottage cheese, that does not usually smell
- itching and irritation around the vulva and vagina
- soreness and stinging during sex or when you pee
Sometimes thrush causes no symptoms at all2. None of these symptoms is unique to thrush, so other infections can look similar1.
| Thrush | Bacterial vaginosis | Trichomoniasis | |
|---|---|---|---|
| Discharge | Thick, white, like cottage cheese | Thin, grey-white, watery | Yellow-green, may be frothy |
| Smell | Usually none | Strong fishy smell, often after sex | May smell fishy |
| Itch or soreness | Common | Not usually | Common |
| Is it an STI? | No | No, but sex can trigger it | Yes |
| Treatment | Antifungal | Antibiotics | Antibiotics |
How thrush is treated
You usually need antifungal medicine. This can be a tablet you swallow, a tablet you put in the vagina (a pessary), or a cream to ease the itch2. Thrush should clear within 7 to 14 days of starting treatment. Partners do not need treatment unless they have symptoms2.
If you have had thrush diagnosed before and know the symptoms, you can buy treatment from a pharmacy. But do not use it more than twice in 6 months without speaking to a pharmacist or doctor2.
Good to know
Antifungal creams can damage condoms and diaphragms, so your contraception may not work during treatment2.
When thrush keeps coming back
If you get thrush more than 4 times in 12 months, it is called recurrent thrush. You may need treatment for longer, up to 6 months. A GP can help find a trigger, such as your period or sex2.
If you’re pregnant or breastfeeding, see a GP or midwife before treating thrush2. In pregnancy, creams or pessaries used for 7 days are recommended, not tablets you swallow1.
When to see a doctor
- It’s your first time having thrush symptoms2.
- You’re under 16 or over 60, pregnant or breastfeeding2.
- Thrush keeps coming back, or treatment hasn’t worked2.
- You have a weakened immune system, for example because of diabetes2.
- Your discharge smells or is green or yellow.
- Pain in your lower tummy or pelvis with a fever, unusual discharge or bleeding could be PID. Ask for an urgent GP appointment or call 111. Call 999 or go to A&E if the pain is severe, you have a very high temperature, feel faint, or could be pregnant6.
Quick check: How many times in a year counts as recurrent thrush?
More than 4 times in 12 months2.
References
- Workowski KA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021: Vulvovaginal candidiasis. Centers for Disease Control and Prevention. www.cdc.gov/std/treatment-guidelines/candidiasis.htm
- NHS. Thrush in men and women. www.nhs.uk/conditions/thrush-in-men-and-women/
- Sobel JD. Vulvovaginal candidosis. Lancet. 2007;369(9577):1961-1971. doi.org/10.1016/S0140-6736(07)60917-9
- NHS. Bacterial vaginosis. www.nhs.uk/conditions/bacterial-vaginosis/
- NHS. Trichomoniasis. www.nhs.uk/conditions/trichomoniasis/
- NHS. Pelvic inflammatory disease. www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/
How we rate evidence. Strong: systematic reviews, large studies or national and international guidelines. Moderate: a single good-quality study, expert reviews or official guidance on a narrower question. Limited: one observational study or little direct research. Early: small or pilot studies that need confirming.
This article is for general information and does not replace medical advice. If you are worried about your symptoms, contact your GP, a sexual health clinic, NHS 111 or, in pregnancy, your midwife.
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