Thrush: symptoms, diagnosis, and treatment
Written in association with:In this article below, esteemed consultant in sexual and reproductive health, Dr Emily Lord, provides us with an all-you-need-to-know guide about thrush, including the symptoms, diagnosis, and treatment.
What is thrush?
Thrush is an infection caused by an overgrowth of a yeast called candida. It can occur both in men and women. Candida albicans are the most common type, but there are others. It is important to remember that candida can live harmlessly in various parts of your body. It is only when there is an overgrowth that it tends to cause symptoms known as candidiasis. It can cause oral or genital infection, or more rarely invasive candidiasis, which affects the bloodstream and/or internal organs.
While thrush can occur in anyone, it is more frequently found in women, with 75 per cent experiencing it at least once in their lifetime. There are certain factors that make it more common, for example:
- Hormonal causes:
- Some oral contraceptives
- Pregnancy
- Changes in the menstrual cycle
- A recent course of antibiotics
- Medical conditions, such as diabetes
- Immunodeficiency (caused by immunosuppressive treatments or conditions like untreated HIV)
What are the symptoms of genital thrush?
Women usually develop symptoms such as vaginal itch, soreness, and a burning sensation. The outer vagina (vulva) may look red or swollen, and sometimes there are skin cracks. Most women will have a change to their normal vaginal discharge. It can vary - but is often described as white and clumpy - like cottage cheese. Women may experience discomfort during sexual intercourse, and it can also sometimes hurt when they pee, as the urine hits the sore skin.
The symptoms men develop also vary, initially they may experience a red blotchy rash on the head of their penis. This may be uncomfortable, or itchy. It can also affect the foreskin, causing tightness, swelling, and skin cracks. This can be painful, and it might mean the foreskin is hard to pull back. It’s important to get help quickly in these situations.
If a man develops severe or recurrent genital thrush, then he should be checked for underlying causes, such as diabetes. While thrush is not an STI, if a female sexual partner has thrush, they may develop it themselves.
How is thrush diagnosed?
Sometimes it is possible to diagnose people based on the history. A common example is a female who has had a recent course of antibiotics, and a few days later develops vaginal itch, soreness, and a new discharge. In cases like this, a trip to your local pharmacy can be helpful, as you can buy treatment over the counter.
How is thrush treated?
In most people, simple antifungal agents can quickly treat an isolated episode of uncomplicated thrush, for example, clotrimazole or fluconazole. These can be purchased from a pharmacy or prescribed from your doctor. It is also important to look after your genital area, to only wash once a day and to avoid any soaps, bath products, and washing only with a simple soap substitute (emollient). It is also worth wearing cotton underwear and breathable clothing.
What is recurrent thrush?
Some people continue to suffer thrush, even though they follow all the advice of their doctor and try multiple therapies. Recurrent thrush is defined as at least four episodes of thrush in one year. Patients either describe responding fully to treatment, but then their symptoms quickly come back, or treatment doesn’t help at all, or improves things minimally. It is usually associated with poorly controlled diabetes, immunosuppression, and increased levels of oestrogen, due to contraception, HRT, or pregnancy.
Recurrent thrush can be demoralising and affect a person’s quality of life. On these occasions, it is important to see an expert who can help ensure that all contributory factors are considered. Treatment of recurrent thrush can be more challenging, and this has been hampered by the fact that some recommended medications are not available.
For further information:
- UK national guideline: British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019) (bashhguidelines.org)
- Patient information: Thrush in men and women - NHS (www.nhs.uk)
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