How is thrush diagnosed?
You do not always need a test to diagnose thrush. The diagnosis is often based on the typical symptoms and signs. However, it is important that you do not assume that a vaginal discharge is thrush. There are other causes of vaginal discharge. It is reasonable to assume it is thrush if:
- You have a vaginal and/or vulval itch.
- Any discharge you have does not smell and is white or creamy.
- You have no abnormal bleeding.
However, if you have assumed you have thrush and you have had treatment, but the symptoms have not gone away, you may need to have tests. See your doctor, who may examine you and may perform some tests.
If tests are needed they may include:
- A test to see how acidic the vagina is (a pH test). The level of acidity gives an indication of whether a discharge is due to thrush or to bacterial vaginosis. This is the basis of the over-the-counter test for thrush. A test strip is placed into the vagina and then the colour change indicates if thrush is likely or not. A pH level of 4.5 or less suggests thrush. Some doctors may also use this test.
- A swab. This is a stick with a cotton bud at the end of it. A sample of discharge is taken from the vagina and analysed in a lab. This indicates if you have thrush or another infection. It can also inform the doctor which type of candida you have.
- Tests for other infections. Further swabs may be taken to be sure you do not have other types of vaginal infections.
- Urine tests. Your urine may be checked for sugar. This is to check you do not have diabetes, as this would make you more prone to thrush. This might be done if you were getting repeated (recurring) episodes of thrush. Urine may also be checked for infection, as sometimes it can be difficult to distinguish between a urine infection and thrush.
Do I need to see a doctor if I get vaginal thrush?
If you have had thrush in the past and the same symptoms come back then it is common practice to treat it without an examination or tests. Many women know when they have thrush and treat it themselves. You can buy effective treatments without a prescription from pharmacies. You can read about these in the treatment section.
However, remember a vaginal discharge or vulval itch can be due to a number of causes. So, do not assume all discharges or itches are thrush. The following gives a guide as to when it may be best to see a doctor or nurse if you think that you might have thrush. If you:
- Are under 16 or over 60 years of age.
- Are pregnant.
- Have treated yourself with a thrush treatment from the chemist, but your symptoms have not gone away.
- Have abnormal vaginal bleeding.
- Have lower tummy (abdominal) pain.
- Are unwell in yourself in addition to the vaginal and vulval symptoms.
- Have symptoms that are not entirely the same as a previous bout of thrush. For example, if the discharge has a bad smell, or it you develop ulcers or blisters next to your vagina.
- Have had two episodes of thrush in six months and have not consulted a doctor or nurse about this for more than a year.
- Have had a previous sexually transmitted infection (or your partner has).
- Have had a previous bad reaction to anti-thrush medication or treatments.
- Have a weakened immune system - for example, if you are on chemotherapy treatment for cancer or are taking long-term steroid medication for whatever reason.
And if you do treat yourself, see a doctor or nurse if the symptoms do not clear after treatment.
Further reading and references
Sexually Transmitted Infections in Primary Care; Royal College of General Practitioners and British Association for Sexual Health and HIV (Apr 2013)
Candida - female genital; NICE CKS, November 2016 (UK access only)
Martin Lopez JE; Candidiasis (vulvovaginal). BMJ Clin Evid. 2015 Mar 162015. pii: 0815.
British National Formulary; NICE Evidence Services (UK access only)
Abad CL, Safdar N; The role of lactobacillus probiotics in the treatment or prevention of urogenital infections - a systematic review. J Chemother. 2009 Jun21(3):243-52.
Fischer G, Bradford J; Vulvovaginal candidiasis in postmenopausal women: the role of hormone replacement therapy. J Low Genit Tract Dis. 2011 Oct15(4):263-7. doi: 10.1097/LGT.0b013e3182241f1a.
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