Vaginal thrush is one of the most common vaginal infections, and most women will have at least one episode in their lifetime. It is caused by an overgrowth of a yeast — usually Candida albicans — that normally lives harmlessly in the body. Thrush is not classed as a sexually transmitted infection, and having it does not mean anything is wrong with your hygiene.
What vaginal thrush is and typical symptoms
Thrush develops when the natural balance of the vagina shifts and yeast multiplies more than usual. Common triggers include a recent course of antibiotics, pregnancy, poorly controlled diabetes, and hormonal changes. Tight or synthetic underwear, and perfumed soaps, shower gels and vaginal washes that irritate the delicate skin, can also make symptoms more likely for some women, although they are not the underlying cause.
Thrush is most common during the reproductive years, when oestrogen levels are higher, and episodes often cluster around the time of a period. It is much less common before puberty and after the menopause, so new symptoms at those times deserve a closer look rather than assuming thrush. If you are choosing or reviewing contraception and find thrush is a recurring nuisance, it is worth mentioning it — our comparison of combined and progestogen-only contraception covers what a clinician checks.
Typical symptoms are itching and soreness around the vulva and vagina, a thick white discharge that is often described as looking like cottage cheese but usually does not smell, and stinging or discomfort when passing urine or during sex. In more pronounced episodes the vulva can look red and swollen, and small splits (fissures) in the skin can make sitting or passing urine uncomfortable. Symptoms range from mild to intense and often build over a few days.
Because itching and discharge can have other causes, it is worth being sure of the diagnosis, particularly if this is your first episode, if symptoms are unusual for you, or if there is an offensive smell. Bacterial vaginosis, for example, tends to cause a thin, greyish discharge with a fishy smell rather than the itch of thrush, and some sexually transmitted infections can cause similar symptoms. The burning of a urinary tract infection is different again; if your main symptom is pain on passing urine rather than itch, see our guide to UTI treatment.
Male partners occasionally develop a form of thrush affecting the head of the penis, with redness, itching and soreness, especially if uncircumcised. Routine treatment of partners who have no symptoms is not usually needed, but a partner who does have symptoms should seek their own advice.
First-line treatment — fluconazole and clotrimazole
For an uncomplicated episode of thrush, treatment is simple and usually works quickly. The two first-line options in the UK are a single oral dose of fluconazole 150mg, or a single clotrimazole 500mg pessary inserted into the vagina. Both are effective, and the choice often comes down to preference — some women prefer a capsule they can swallow, others prefer a pessary.
A pessary is usually inserted at night so it stays in place, and using a panty liner helps as the base can leak a little as it dissolves. If you choose the oral capsule, it is a single dose that works from the inside. Whichever route you use, an external clotrimazole cream can be added to ease vulval itching, but it is not a substitute for treating the infection itself.
Symptoms usually begin to improve within a few days, although itching and soreness can take a little longer to settle fully as the skin recovers. If you are no better after about a week, or symptoms return quickly, that is a reason to check back with a clinician rather than simply repeating the same treatment. It is also worth avoiding sex until things have settled, as friction can aggravate already sore and inflamed skin and delay healing.
Fluconazole is not suitable in pregnancy, so a clotrimazole pessary is the preferred route when fluconazole cannot be used — for example during pregnancy, or where a medicine you take interacts with it. Your clinician will advise based on your individual circumstances.
What counts as recurrent thrush
Most women have the occasional episode. Recurrent thrush is defined as four or more symptomatic episodes in a year. This is common enough to have a clear management approach, but it does deserve proper assessment rather than repeated one-off treatments — because something may be driving the pattern, such as poorly controlled blood sugar, and because occasionally the yeast involved is a less common, harder-to-treat species. It is also worth confirming the original diagnosis was correct, because conditions that mimic thrush can otherwise be treated repeatedly and unsuccessfully as though they were a yeast infection.
Induction and maintenance for recurrent thrush
When thrush is genuinely recurrent, a two-stage plan is used. The first stage — induction — clears the current infection more thoroughly, typically with oral fluconazole 150mg taken every 72 hours for three doses. The second stage — maintenance — aims to keep it from returning, usually with a weekly fluconazole 150mg dose continued for six months.
A clotrimazole pessary regimen is an alternative where fluconazole cannot be used, and can be arranged along similar induction-and-maintenance lines. Many women find their symptoms are much better controlled during maintenance; some episodes return after the six months, in which case the plan can be reviewed. Because this involves regular prescription medicine, it is set up and monitored by a clinician, who will usually review how you are getting on, check for side effects, and consider any triggers that can be reduced — for example improving blood sugar control in diabetes.
Self-care and what does not help
Alongside treatment, a few simple measures can ease symptoms and may reduce recurrences for some women: wear cotton underwear, avoid tight synthetic clothing, and skip perfumed soaps, bubble baths and vaginal washes, which can irritate the skin. There is no need to douche — the vagina cleans itself, and douching can upset its natural balance and make matters worse.
Some remedies are popular but not well supported by evidence, and a few can make soreness worse. You may read that cutting out sugar or yeast from your diet, or taking probiotics, prevents thrush; the evidence for these is weak, and they are no substitute for treating an active infection. If a self-care measure irritates the skin, stop it. The most reliable step remains getting the diagnosis right and treating the infection appropriately.
When to see a clinician
See a clinician rather than self-treating if this is your first episode, if you are under 16 or over 60, if you are pregnant or breastfeeding, if you have had two episodes in six months, if symptoms are not fully better within a week of treatment, or if you have unusual bleeding, sores, an offensive-smelling discharge, or pain in the lower abdomen. Women over 60 who develop new symptoms may also benefit from a wider review, as changes discussed in our menopause guide can affect vaginal tissues.
Treatment that does not work can point to a non-albicans yeast species or a different diagnosis altogether, and warrants review. If there is any chance your symptoms could be a sexually transmitted infection rather than thrush, a sexual health check can be arranged discreetly. You can explore related topics across our Women's Health articles, and if you are unsure whether your symptoms are thrush at all, a short consultation can help sort it out.