Genital thrush is caused by a yeast infection, usually the yeast called candida albicans.

Symptoms of thrush in women can include soreness and irritation in and around the vagina, with redness and inflammation of the skin and, in more severe cases, swelling of the entrance to the vagina.

The inflammation of thrush can cause burning when passing urine (dysuria). Active thrush can also produce a discharge, usually described as cheese-like, although it can be creamy or mucous-like. In very severe cases the skin can crack and ulcerate.

In men thrush can cause red spots or a rash on the head of the penis.

Why some people get thrush

Most women and men who get thrush symptoms are entirely healthy. The yeast causing thrush is naturally occurring and is often present in the vagina and in other places on the body. It normally does not cause symptoms.

The reason thrush becomes active and produces symptoms from time to time in some people is not well understood. Symptomatic thrush is more common with diabetes, in pregnancy, when antibiotics are being taken, and when there is a generalised illness reducing the body's immunity. In most cases thrush just flares up for no known reason.

Treatment for thrush

We provides the most widely used types of capsules and creams to treat thrush. These treatments are with drugs called imidazoles: Canesten contains the imidazole clotrimazole, while Diflucan capsules contain fluconazole.

Sometimes it is useful to change from one imidazole to another when one treatment has not worked.

For women

Thrush in women is usually treated with pessaries (vaginal tablet) or cream inserted in the vagina and creams applied to the skin around the entrance to the vagina. The pessary or vaginal cream can be either a single one-off dose or daily dose for 3-6 days. The external cream is usually applied 2-3 times daily for a week.

Alternatively there is a single-dose antifungal capsule Diflucan (fluconazole 150mg) to treat thrush. This antifungal medication eliminates thrush from the body, including thrush in the vagina. This capsule treatment may be more effective, in some cases, than pessaries and creams. A capsule is less messy to use. It is possible to use both capsules and creams and pessaries at the same time.

For men

Thrush in men is usually treated by applying a cream to the head of the penis 2-3 times daily for 10-14 days. Thrush in men can also be treated by taking the same single-dose antifungal capsule (fluconazole 150mg) as is used to treat thrush in women.

Response to treatment

Symptoms of thrush usually settle completely within 10 days of starting treatment. Women prone to repeated episodes of thrush often need to repeat treatment every few weeks or months.

If thrush symptoms have not resolved within 10 days medical advice should be sought.

Do partners need treatment for thrush?

Thrush is not a sexually transmitted disease in the sense that the yeast that causes the infection is present naturally and can flare up without any sexual contact. However, men and women can pass infection backwards and forward from penis to vagina, with often only one partner having symptoms of thrush.

For women who get regular thrush there is sometimes a benefit in treating male partners simultaneously. Similarly, in men who have irritation at the head of the penis caused by thrush, simultaneous treatment of female partners may reduce recurrence.

Side effects

Creams and pessaries may cause skin irritation.

Very little of the active ingredients of creams and pessaries are absorbed into the body.

The more common side effects for the antifungal capsule (fluconazole/Diflucan 150mg single-dose) are gastrointestinal symptoms such as nausea, abdominal pain, diarrhoea, and flatulence. Other adverse events such as a rash are encountered rarely. Headache has been associated with fluconazole 150mg oral capsule. For other rare side effects see the manufacturer's patient information leaflets included with medicine packs.

Cautions

• If a diagnosis of thrush has not been made previously it is best to consult with your regular doctor to confirm the diagnosis.
• Symptoms not resolving within 10 days require investigation.
• Pregnant women should not take fluconazole capsules or use vaginal preparations without consulting their own GP or midwife.
• There is a very rare theoretical risk of abnormal heart rhythm if fluconazole is taken at the same time as some other medications - please check this list.
• Thrush treatments do not deal with sexually transmitted disease. If sexually transmitted disease is suspected investigations are needed by a GP or Sexual Health Clinic.

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