Topical thrush treatments
These are pessaries and creams which you insert into the vagina with an applicator. They contain anti-yeast medicines such as clotrimazole, econazole, miconazole or fenticonazole. A single large dose inserted into the vagina is often sufficient to clear a bout of thrush. Alternatively a lower dose is used for several days. You may also want to rub some anti-thrush cream on to the skin around the vagina (the vulva) for a few days, especially if it is itchy. In mild cases, or for girls under the age of 16, a cream for the skin may be all that is needed.
You can obtain topical treatments on prescription, or you can buy some of them without a prescription at pharmacies. Side-effects are uncommon, but read the information leaflet that comes with the treatment for full information.
In general, you can use these topical treatments if you are pregnant but you should always check with your doctor or pharmacist. Treatment is usually needed for longer during pregnancy.
Note: some pessaries and creams may damage latex condoms and diaphragms and affect their use as a contraceptive. You should use alternative methods of contraception during treatment and for several days afterwards.
Two options are available. Fluconazole, which is taken as a single dose, or itraconazole which is taken as two doses over the course of one day. You can obtain these treatments on prescription; you can also buy fluconazole without a prescription from pharmacies. Side-effects are uncommon, but always read the information leaflet that comes with the treatment for full information. Do not take these treatments if you are pregnant or breast-feeding. You may also want to rub some anti-yeast cream on to the skin around the vagina for a few days, especially if it is itchy. Combination packs containing both the tablet and the cream are available. In severe infection, a repeat dose of the tablet may be suggested after three days.
Note: tablets and topical treatments are thought to be equally effective. Tablets are more convenient but are more expensive than most topical treatments.
If you are in a sexual relationship, there is no need to treat your partner too unless they also have symptoms.
Other things that may help
If you have thrush, you may also find the following things help to relieve your symptoms:
- Avoiding wearing tight-fitting clothing, especially clothing made from synthetic materials. Loose-fitting, natural-fibre underwear may be better.
- Avoiding washing underwear with biological washing powders or liquids and avoiding the use of fabric conditioners.
- Avoiding using perfumed products around the vaginal area, such as soaps and shower gels, as these may cause further irritation.
- Using a simple emollient every day as a moisturiser to protect the skin around the vulva.
- Yoghurt containing probiotics, either eaten or applied to the vagina, may be helpful; however, there is not yet enough evidence to know if it is proven to be effective.
What if the treatment doesn't work?
If you still have symptoms a week after starting treatment then see your doctor or nurse. Treatment does not clear symptoms in up to 1 in 5 cases. Reasons why treatment may fail include:
- The symptoms may not be due to thrush. There are other causes of a vaginal discharge. Also, thrush can occur at the same time as another infection. You may need tests such as vaginal swabs (samples taken using a small ball of cotton wool on the end of a thin stick) to clarify the cause of the symptoms.
- Most bouts of thrush are caused by C. albicans. However, about 1 in 10 bouts of thrush are caused by other strains of Candida spp., such as C. glabrata. These may not be so easily treated with the usual anti-thrush medicines.
- You may not have used the treatment correctly.
- You may have had a quick recurrence of a new thrush infection. (This is more likely if you are taking antibiotic medication, or if you have undiagnosed or poorly controlled diabetes.)
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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