Vaginal Thrush
An overgrowth of yeast (candida) causing itch, soreness and thick white discharge. Common, not an STI, and usually cleared in days. Just make sure it’s actually thrush.
The thrush ladder
Most people only need steps 1–3. If you’re climbing past that, get a swab first: plenty of “thrush” turns out to be something else.
- Step 1 · Self-careBe kind to the areaWater or a soap-free wash, cotton underwear, no douching, no scented products.
- Works
- Not tested in trials; sensible and low risk. Eases irritation, but won’t clear an active infection
- Cost
- Free
- How long
- Ongoing
- Watch for
- Itch with a fishy smell, grey or green discharge, sores or blisters isn’t typical thrush.
Your vagina is self-cleaning. It did not ask for a floral body wash.
- Step 2 · PharmacyAntifungal cream or pessary (clotrimazole)Inserted into the vagina with an applicator; 1-, 3- and 6-day options.
- Works
- Clears symptoms in about 8 in 10 people within 1–2 weeks
- Cost
- About $10–20
- How long
- 1–6 days, depending on the product. Itch can take a few more days to fade.
- Watch for
- Mild burning. Can weaken condoms and diaphragms while you’re using it.
Longer courses are gentler and better for severe symptoms. The 1-day option is not more powerful, just more impatient.
- Step 3 · PharmacyAntifungal tablet (fluconazole), single doseOne capsule by mouth, from a pharmacist.
- Works
- Same as the creams: about 8 in 10 clear (Cochrane)
- Cost
- About $10–25
- How long
- One dose; symptoms ease over a few days
- Watch for
- Not in pregnancy or while breastfeeding without advice. Interacts with some medicines, including some blood thinners and statins.
No applicator, no mess. Just tell the pharmacist what else you take.
- Step 4 · PrescriptionLonger or repeated antifungal coursesFor severe thrush, or recurrent thrush (4 or more episodes a year): an initial course, then weekly fluconazole for about 6 months.
- Works
- About 9 in 10 stay clear on weekly treatment vs 1 in 3 on a dummy treatment; 6 months after stopping, about 4 in 10 still clear
- Cost
- Private script; cost varies with pack size and pharmacy
- How long
- Usually 6 months, then review
- Watch for
- Needs a swab first to confirm it’s thrush. Same interaction and pregnancy cautions as above.
Swab first, treat second. Guessing four times a year isn’t a plan.
- Step 5 · SpecialistSexual health or gynaecology clinicFor thrush that won’t clear, unusual yeast types, or itch that isn’t thrush (such as skin conditions of the vulva).
- Works
- Not tested as a step in trials; lab testing and targeted treatment sort out tricky cases
- Cost
- Public sexual health clinics are often free; private specialist fees vary
- How long
- Depends on the cause
- Watch for
- Some specialist treatments (such as boric acid pessaries) are toxic if swallowed and not for use in pregnancy.
If it keeps coming back, it’s time for detective work, not another box from the shelf.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Yoghurt or garlic in the vaginaThe evidence is thin and the mess is real. Garlic can also burn delicate skin.
- Probiotic tabletsLow-quality evidence they might help a little alongside antifungals, and no good evidence on their own.
- Tea tree oil pessariesNo good evidence, and a common cause of irritation. The last thing an itchy vulva needs.
- The ‘candida diet’No evidence that cutting sugar or yeast prevents thrush. Your cake is innocent.
- ‘Candida overgrowth’ testsStool, blood or online tests for ‘systemic candida’ aren’t valid. A swab from the right place is the test.
What you can do
- If it’s your first time, get it checked before you self-treat.
- Cotton underwear, and change out of wet swimmers and sweaty gym gear promptly.
- If thrush follows every course of antibiotics, ask about having treatment on hand.
- Partners don’t need treating unless they have symptoms.
See your GP if
- It’s your first episode, or you’re under 16 or over 60
- You’re pregnant or breastfeeding
- You get it 4 or more times a year, or have diabetes
- Discharge smells, is grey, green or bloody, or you have sores, blisters, pelvic pain or fever
- It isn’t better a week after treatment
Pregnant? Use a vaginal cream or pessary (a 7-day course is usual) and skip fluconazole tablets. Check with your doctor or pharmacist first.
Common questions
Is thrush a sexually transmitted infection?
No. It’s an overgrowth of yeast that normally lives in the body. Sex can irritate it, but partners don’t need treatment unless they have symptoms.
Cream or tablet: which is better?
They work about as well as each other. Tablets are less messy; creams act locally and are the choice in pregnancy.
Why does thrush keep coming back?
Common reasons are antibiotics, diabetes, hormone changes, or it not being thrush in the first place. Four or more episodes a year needs a swab and a longer treatment plan.
Do probiotics prevent thrush?
They might help a little, but the evidence is weak. They’re safe to try, just don’t rely on them.
Helpful resources
- Jean Hailes: Vulvovaginal thrushClear, independent women’s health information on thrush and lookalike conditions. Free.
- Vaginal thrush fact sheet (Sexual Health and Family Planning ACT)One-page guide including recurrent thrush. Free PDF.
Evidence and more information
- Healthdirect: Vaginal thrush
- Healthdirect: Vaginal thrush treatments
- NICE CKS: Candida, female genital
- Cochrane for Clinicians: oral vs vaginal antifungals for thrush
- Sobel et al, NEJM 2004: weekly fluconazole for recurrent thrush
maladywise.com/thrush/