Thrush in men and women (candidiasis)
Thrush is an overgrowth of the yeast candida in places where it already lives: the lining of the vagina, the skin of the head of the penis, the folds of the…
On this page
- A fungus that everybody carries
- What it looks like
- Not a sexually transmitted infection, but it does concern your partner
- How it is treated
- If thrush keeps coming back or will not clear, it is probably not thrush
- When thrush is really about blood sugar
- What not to do
- Pregnancy and other times not to treat yourself
- Online consultation
Medicines commonly prescribed for Thrush in men and women (candidiasis)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: CREAM, 10 mg/gActive substance: clotrimazoleManufacturer: Bayer Hispania S.L.Prescription not requiredDosage form: CAPSULE, 150 mg fluconazoleActive substance: fluconazoleManufacturer: Sandoz Farmaceutica S.A.Prescription requiredDosage form: CAPSULE, 200 mg fluconazoleActive substance: fluconazoleManufacturer: Teva Pharma S.L.U.Prescription required
Thrush is an overgrowth of the yeast candida in places where it already lives: the lining of the vagina, the skin of the head of the penis, the folds of the skin, the mouth. It is not dirt, not neglect and not a sign of sleeping around — an ordinary resident of the body has simply been given the chance to multiply beyond its usual limits. In itself the condition is not dangerous, however miserable it feels. What really matters is something else: several quite different conditions look almost identical, are treated in completely different ways, and it is on those that most of the wasted time goes. There is a separate section about them below.
A fungus that everybody carries
Candida is a normal inhabitant of the human body. It lives in the mouth, in the bowel, on the skin and, in many women, in the vagina, and normally it gives no sign of itself: it is held in check by the neighbouring bacteria and by the defences of the lining itself. Thrush begins when that balance is disturbed and the yeast is given room.
What most often disturbs it:
- A course of antibiotics: they kill bacteria, the useful ones included, and clear space for the yeast.
- Warmth and damp — wet swimwear, tight sports clothing, sweaty skin folds.
- Irritated or damaged skin: after shaving, from friction, from over-enthusiastic washing.
- Pregnancy and shifts in hormones, hormone therapy included.
- A high blood sugar in poorly controlled diabetes.
- Weakened defences: steroid tablets, chemotherapy, HIV.
Often no cause can be found at all, and that is perfectly normal. A single episode of thrush says nothing about your health in general and does not call for a hunt for hidden disease.
What it looks like
In women thrush causes itching and stinging around the vulva and vagina, sometimes severe, together with thick white discharge resembling cottage cheese or curdled milk. It does not usually smell, and that detail matters. The surrounding skin becomes red and swollen, small splits can appear, and because of them passing urine and having sex become painful.
In men the picture is different. The head of the penis and the inner surface of the foreskin turn red, itch and burn, a white coating with an unpleasant smell appears, and the skin can become dry and shiny. Sometimes the foreskin swells and is harder to pull back. This inflammation is called balanitis, and candida is only one of its causes.
Candida also affects other areas: the groin creases, under the breasts, the armpits, between the fingers, the corners of the mouth. There it shows as a moist red patch with a sharp border and small satellite spots around the edge. On brown and black skin the redness is harder to see, but the scaling and swelling are obvious.
It can also cause nothing at all: the yeast turns up on a swab while the person feels perfectly well. In that situation there is nothing to treat.
Not a sexually transmitted infection, but it does concern your partner
Thrush is not classed as a sexually transmitted infection. It occurs in people who have never had sex at all, and it comes from your own flora rather than from somebody else. Sex can nevertheless set it off — through friction, a change in the flora, latex or lubricant — and occasionally the yeast really is passed between partners.
The practical conclusion follows from that. If your partner has symptoms of their own — itching, redness, a white coating — you both need treating at the same time, otherwise you will simply hand the yeast back and forth. If your partner has no symptoms, there is no point treating them just in case.
One more practical detail that almost nobody is warned about: antifungal creams and pessaries damage latex. A condom or diaphragm may split during treatment and your contraception may fail. For the length of the course and a few days afterwards you need another method.
How it is treated
Treatment means antifungal medicines, and they work well. There are two routes, they are roughly equal in effect, and the choice is usually a matter of convenience.
- Local treatment: vaginal pessaries and tablets, creams and ointments for the skin. Courses run from a single day to a week, sometimes longer. They act where the problem is, are barely absorbed and suit almost everyone.
- A tablet or capsule by mouth, usually a single dose. Convenient, but not suitable in pregnancy and it does not combine with every medicine, so this option is worth discussing with a doctor or pharmacist.
The itching usually settles within a couple of days and everything clears within one to two weeks. If the skin is badly inflamed, a doctor may add a mild steroid ointment for a few days to take the itch away while the antifungal does its work.
When you have had thrush before, the diagnosis is established and the picture is exactly the same, it is entirely reasonable to start with something from the pharmacy without seeing anyone. But that rule has a limit: if you find yourself reaching for an antifungal more than twice in six months, treating blind has to stop. What is needed then is an examination and a swab.
If thrush keeps coming back or will not clear, it is probably not thrush
This is the central point of the whole page. Genuine thrush responds to treatment quickly. When "thrush" keeps returning or refuses to yield to any course, the likeliest explanation is that the diagnosis was wrong in the first place, usually made at home on the strength of itching and discharge. The conditions that masquerade as it are these:
- Bacterial vaginosis — a shift in the flora rather than a yeast. The discharge is thin and greyish with a distinct fishy smell, and there is often no itching at all. It is treated with antibiotics, and antifungals do nothing for it.
- Trichomoniasis — this one genuinely is a sexually transmitted infection. Copious frothy yellow-green discharge and soreness. Both partners are treated, and treated with an antibiotic.
- Irritation and contact dermatitis — from scented pads and panty liners, wet wipes, intimate washes, laundry detergent, and in men from soap left under the foreskin. There is itching but no discharge, and it settles once the culprit is removed.
- Lichen sclerosus — stubborn itching, with skin that becomes white, thin and shiny and splits easily. It needs a doctor and treatment with a strong steroid ointment; without it the anatomy changes and the risk of skin cancer rises.
- Genital herpes — pain outweighs itching, and there are blisters and painful ulcers.
- Eczema and psoriasis in the area and, after the menopause, thinning of the lining from lack of oestrogen, which causes dryness and burning.
- In men, balanitis is not always fungal: it comes from poorly rinsed soap, from irritation and, not rarely, on the background of diabetes.
The right move when symptoms keep coming back is not a third course chosen at random but an examination and a swab. Genuinely recurrent thrush does exist, and it is treated with a maintenance regimen over several months, but the starting point is still making sure of the diagnosis.
When thrush is really about blood sugar
Diabetes deserves a paragraph of its own, because the link runs both ways. When blood sugar is high, glucose appears in the urine and in the secretions and feeds the yeast, so people whose diabetes is poorly controlled get thrush often and clear it with more difficulty.
But it also works the other way round: recurrent thrush turns out to be the first noticeable sign of diabetes that the person did not know they had. In men this is especially characteristic — persistent balanitis in an adult man is one of the recognised reasons to check the blood sugar. The check is simple: a blood glucose test and, if needed, a glycated haemoglobin.
All the more reason to do it if the thrush comes alongside thirst and a dry mouth, passing urine often and especially at night, unexplained weight loss or constant tiredness.
What not to do
A good share of the cases that drag on are kept going not by the yeast but by what the person is using against it.
- Do not douche. Douching washes out the protective flora and makes the next episode more likely, and where there is an infection it can carry it higher up.
- Do not wash the lining with soap, shower gel, bubble bath or scented intimate products. On the outside warm water or an unperfumed emollient is enough; nothing needs washing on the inside.
- Do not try home remedies: yoghurt, bicarbonate of soda, garlic, essential oils, boric acid. None of them is proven, and they irritate the lining further.
- Do not abandon the course on day two when the itching stops: a half-treated episode comes back.
- Do not refuse an examination and a swab out of embarrassment. For a doctor this is an everyday consultation.
- Do not live in tight synthetic underwear and daily liners, and do not sit around in a wet swimming costume. Cotton underwear and staying dry are the simplest things that genuinely help.
Pregnancy and other times not to treat yourself
Thrush is common in pregnancy and in itself it poses no threat to the baby. But the treatment is different here: tablets by mouth are not usually used, the regimen is chosen by a doctor, and it is generally a local treatment given over a longer course. Buying an antifungal for yourself while pregnant is not the way to go about it.
There are other situations that call for a doctor rather than a pharmacy:
- Symptoms like these have appeared for the first time in your life — the diagnosis needs confirming at least once.
- The symptoms are in a child or a teenager.
- Thrush against a background of diabetes, steroid treatment, chemotherapy or weakened immunity.
- It returns more than three or four times a year, or it has not cleared after a course of treatment.
- There is any risk of a sexually transmitted infection: a new partner, unprotected sex, symptoms in your partner.
Seek help the same day if signs appear that do not belong to thrush at all: fever and shivering, pain low in the abdomen, bloodstained or purulent discharge, ulcers, a rash over the body and, in men, marked swelling of the head of the penis or a foreskin that has been pulled back and will not return. That last one is a trapped foreskin, and it cannot wait.
Online consultation
Thrush is exactly the sort of thing people treat themselves for months on end, precisely because taking it anywhere feels awkward. Talking to a doctor online removes that barrier, and here the questions alone yield a great deal.
In a consultation the doctor will work through what is actually happening: the character of the itch, the look and smell of the discharge, the link with your cycle, with antibiotics, with a new partner or a change of toiletries. They will tell you whether a pharmacy product will do or a swab is needed, explain what to do about repeated episodes, help you plan a blood sugar check and go through what can safely be used in pregnancy.
What an online consultation does not replace: examination and a swab when symptoms appear for the first time or keep returning, and, with swelling, fever or severe pain, being seen in person the same day.
This material is for information only and does not replace medical advice.
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