Written for Stock My Medicine and clinically reviewed by Hajra Dhanchora, MPharm (GPhC 2216990).
Thrush is a yeast infection, not a sexually transmitted one, and it is one of the most common reasons anyone walks into a pharmacy. Three in four women get it at least once, men get it too, and babies get it in the mouth. The good news is that the treatments work quickly and you can buy all of them without a prescription. Here's how to recognise it, what sets it off, and how to choose between a pessary, a cream and a capsule.
What is thrush, and what does it look like?
Thrush is an overgrowth of Candida, a yeast that lives harmlessly on most people's skin and in the gut and vagina until something tips the balance. In women the classic signs are a thick white discharge that looks like cottage cheese and usually doesn't smell, itching and soreness around the vulva and vagina, stinging when you pee or during sex, and sometimes redness and small cracks in the skin. In men it shows as irritation, burning and redness around the head of the penis and under the foreskin, a white lumpy discharge, an unpleasant smell, and a foreskin that's harder to pull back. Oral thrush is creamy white patches on the tongue and inside the cheeks that can be wiped off to leave a red, sore surface underneath; it's common in babies, denture wearers and people using steroid inhalers. Thrush can also settle in warm skin folds such as the groin, under the breasts and the armpits, where it looks like a moist red rash with a scaly edge.
What causes thrush?
Anything that disturbs the balance of bacteria and yeast, or that damages the skin's defences. The big ones are a course of antibiotics (they kill the friendly bacteria that keep Candida in check, so thrush a week after antibiotics is very common), pregnancy and the hormonal shifts of the pill, poorly controlled diabetes, a weakened immune system, and skin that's already irritated by perfumed soaps, tight synthetic underwear or sex. Thrush isn't classed as a sexually transmitted infection, but it can occasionally be passed to a partner, which is why a man sometimes gets symptoms after his partner has had it.
Does thrush go away on its own?
A very mild episode sometimes settles as the balance rights itself, but most don't, and untreated thrush tends to get more sore rather than less. With treatment you should feel better within a day or two and be clear within a week; the NHS puts the outer limit at 7 to 14 days. If nothing has changed after 7 days of treatment, see a GP rather than buying a second pack, because the diagnosis may be wrong.
How to get rid of thrush: the treatments compared
Every pharmacy treatment for vaginal thrush is one of two antifungals, clotrimazole (used inside or on the skin) or fluconazole (a capsule you swallow), and the choice is mostly about what suits you. All of them are for women aged 16 to 60 who have had thrush diagnosed before; a first episode should be confirmed by a GP or sexual health clinic.
| Treatment | What it is | How it's used | Best for |
|---|---|---|---|
| Canesten pessary or soft gel pessary | 500mg clotrimazole, single dose | Inserted high into the vagina at bedtime, once | Internal symptoms; one-night treatment; can be used in pregnancy on advice (without the applicator) |
| Canesten internal cream | 10% clotrimazole, single dose applicator | Inserted at bedtime, once | Those who find a pessary uncomfortable or dry |
| Canesten external cream | 2% clotrimazole | Thin layer to the vulva 2 to 3 times a day until the itch has gone | External itching and soreness, used alongside a pessary or capsule |
| Canesten Thrush Oral | 150mg fluconazole capsule, single dose | Swallowed once, any time of day | Anyone who prefers a tablet; also licensed for men. Not in pregnancy or breastfeeding |
| Canesten Duo | Fluconazole capsule plus 2% external cream | Capsule once, cream for the outside | Internal and external symptoms together |
Two practical points. Clotrimazole pessaries and creams can weaken latex condoms and diaphragms, so use another form of contraception for a few days after treatment. And pessaries are best finished before a period starts, whereas the capsule works regardless of where you are in your cycle. Fluconazole interacts with a number of medicines, including warfarin and some cholesterol, epilepsy and heart drugs, so tell the pharmacist what else you take; that's what the short set of questions at checkout is for. The full thrush range is here.
Thrush in men
Wash the area with water (no soap) and dry it carefully, then apply clotrimazole 1% cream two or three times a day for up to two weeks, continuing for a few days after it looks clear. The fluconazole capsule is an alternative, and a good one if the skin is too sore to touch. If you have diabetes, if it keeps returning, or if the foreskin is tight and swollen, see a GP.
Oral thrush and thrush in babies
Oral thrush needs an antifungal that stays in the mouth. Daktarin oral gel (miconazole) is licensed from 4 months: hold it in the mouth for as long as possible rather than swallowing straight away, and keep going for a week after the patches have gone. Sterilise dummies and bottle teats, treat the breast at the same time if you're breastfeeding and your nipples are sore, and rinse your mouth after using a steroid inhaler. Denture wearers should soak dentures overnight and treat the mouth and the denture together.
Why do I keep getting thrush?
Four or more episodes a year is "recurrent thrush", and it's worth a GP visit rather than repeated pharmacy packs: a swab confirms it really is Candida, a blood test rules out diabetes, and a longer course of fluconazole over six months usually breaks the cycle. Between episodes, the things that make a difference are boring but effective: cotton underwear, no tight trousers or tights for long days, a plain emollient instead of soap or shower gel on the vulva, no douching or "intimate" washes, drying carefully after swimming, and not staying in a wet swimsuit. Probiotics and cutting sugar have weak evidence; they won't do harm, but they aren't a treatment. Partners only need treating if they have symptoms.
When to see a GP
See a GP or sexual health clinic if this is your first episode, if you're under 16 or over 60, pregnant or breastfeeding, if you've had two episodes in six months, if treatment hasn't worked within 7 days, or if there are blisters or sores, bleeding between periods, pain low in the tummy, or a discharge that's green, grey or smells fishy, because those point to bacterial vaginosis or an STI rather than thrush. A burning feeling when you pee without any discharge or itch is more likely to be cystitis; our cystitis guide covers that. For anything else, ask our pharmacist.
Frequently asked questions
Is thrush contagious?
Not in the way a cold is, but it can be passed on during sex and to a baby during breastfeeding. Avoid sex until it's cleared, mainly because it will be sore.
Can I use a thrush pessary during my period?
Ideally finish the pessary or internal cream before your period starts, as the flow can wash it out. The fluconazole capsule works at any point in the cycle.
How long does thrush last after treatment?
Itching usually eases within a day or two and the discharge clears within a week. Keep using the external cream until the skin is comfortable.