Many women have an occasional bout of thrush, when treatment is usually easy and effective. There is a separate leaflet called 'Thrush - Vaginal' about a first or occasional bout of thrush. However, some women have recurring bouts of thrush, when treatment can be more difficult. This leaflet is for women who have recurring bouts of 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 cases of thrush are caused by Candida albicans but sometimes other types of Candida spp., such as Candida glabrata or Candida tropicalis, are the cause.
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.
Many women have an occasional bout of thrush. In most cases it develops for no apparent reason. However, some women develop recurring thrush. This is defined as a bout of thrush four or more times a year. In most cases, the reason this occurs is not known. Some women just seem more prone to develop thrush than usual.
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 Candida spp. (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.
Of women who get a first bout of vaginal thrush, about 5 in 100 of them will get problems with recurring vaginal thrush.
You do not always need a test to diagnose 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. Thrush is common and many women recognise when they have thrush.
However, there are other causes of vaginal discharge. If symptoms are not typical or the same as you usually get, or if you are having recurring symptoms, then your doctor or nurse may examine you and take small samples of the discharge with swabs. These are sent to the laboratory to confirm the cause of the discharge. Also, the doctor or nurse may also check a urine sample if you have recurring thrush, to rule out diabetes.
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 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.
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.
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 following tips may help. However, they have not been proven to work by research, and their use is based on common practice rather than research studies:
There is no consistent evidence that the contraceptive pill, tampons, or sanitary towels increase the risk of getting thrush as some people may suggest.
If you have recurrent bouts of thrush then one option is simply to treat each bout as and when it occurs. Another option that your doctor may suggest is as follows:
Most women remain clear of thrush during maintenance treatment. After treatment is stopped, many of those treated remain free of thrush, or only get the occasional bout again. However, some women return to getting recurrent thrush. In such cases, if necessary, the treatment plan can be repeated, and maintenance treatment continued for longer.
See your doctor if you develop thrush whilst on maintenance treatment. This may indicate that you have a resistant strain of Candida spp. which may require an alternative treatment.
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:
And, if you do treat yourself, see a doctor or nurse if the symptoms do not clear with treatment.