Itching, soreness and irritation – do I have thrush?
Thrush is most likely a familiar condition for many women. Perhaps you find you get it after taking a course of antibiotics, or if you use a certain bubble bath. Perhaps you’ve never had it but heard enough about it to know the warning signs. However, the first time getting thrush, you may not know what is happening. Is it thrush or another condition causing your discomfort? Many conditions, including other infections, STIs, and skin conditions all produce symptoms similar to those of thrush, so what exactly differentiates them from thrush?
Vulvovaginal thrush (or candidiasis) usually presents with symptoms of soreness, irritation, and an increased vaginal discharge. Typically, the discharge is white in colour, often curdy (like cottage cheese) in appearance, but without a very strong odour. Some women may report feeling uncomfortable around the area when having sex or inserting a tampon. It may sting when urine makes contact with the skin, but should not be painful to actually pass urine. The area may be red, inflamed or even fissured (cracked) in places.1 However, not all women will show symptoms, and in fact some women with thrush are completely asymptomatic.
Thrush is caused by a fungal overgrowth, usually of candida — a type of yeast that lives on the skin. The candida is what causes the genital area to be sore, inflamed, and uncomfortable. The infection irritates the skin, and it is this irritated area that can make having sex and passing urine uncomfortable.
You may find you are particularly prone to thrush after taking a course of antibiotics. Antibiotics are taken to treat bacterial infections. However, as well as treating your infection, they can also remove the bacteria that normally lives on the surface of your skin. These bacteria are important for helping control candida growth, and maintaining a balance of the skin flora. If these bacteria are destroyed, it results in candida overgrowth, and thrush.2
Could my symptoms be something else?
There are a few other conditions that may present with itching, soreness, or discharge. These include bacterial vaginosis (BV), trichomonas vaginalis (TV), skin conditions such as eczema or contact dermatitis, and a range of sexually transmitted infections too.
Bacterial vaginosis (BV)
Bacterial vaginosis, or BV, is actually a very common condition, but is less well-known than thrush. Typically, it presents with increased vaginal discharge, which is watery and white or grey in colour. The discharge has a strong fishy smell that is worse after intercourse. Understandably, it is often this that brings women to see the doctor. BV does not usually cause marked soreness or itching, but every women is different.3 For most women, BV is not serious. It is, however, particularly important to diagnose and treat BV in pregnant women. This is because a link has been found between BV and certain pregnancy complications such as increased risk of premature birth.4
BV occurs when the natural balance of bacteria normally present in the vagina (the vaginal flora) changes. This causes a change in the balance of chemicals in the vagina, and a more alkaline environment, resulting in the characteristic smell. BV is not a sexually transmitted infection, but you are at higher risk of developing it if you are sexually active. Exactly why this is, we do not know. There is no evidence to suggest that the bacteria that causes BV can affect male sexual partners, but there is some to suggest that women who have BV may be able to pass it on to other female partners.3
You do not need to be sexually active to develop BV, however, you may also be at increased risk if you regularly use scented soaps, bubble baths, or feminine washes, or have a coil fitted (intrauterine device or IUD). Vaginal douching is thought to increase the risk, too.
A short course of antibiotics is typically used to treat BV, usually as a course of tablets or an antibiotic gel that is locally applied. The tablets are a type of antibiotic called metronidazole, and are usually taken for 5 to 7 days. BV usually resolves following treatment, but up to a half of women find their symptoms return within 3 months of treatment. The key is to look at lifestyle factors, such as use of bubble baths, to help stop the BV returning.
Trichomoniasis (TV) is a sexually transmitted infection (STI) that affects both men and women, caused by a tiny parasite, trichomonas vaginalis. Women may develop symptoms of soreness, itching, and irritation around the vagina with an altered vaginal discharge that is often thin or frothy, a yellow green colour, and has a fishy smell. They may feel discomfort when passing urine or having sex.
In women, only a half of those infected actually have symptoms. Therefore if your partner has symptoms and you don’t, make sure you get tested. The way TV is diagnosed in women is by a swab taken from the vagina. This is usually done at a GUM clinic, but many GPs offer the service too. If you are diagnosed with TV, it is very important that your current (and recent) sexual partners are tested too because they may not have symptoms but may be infected.3
In pregnant women, TV increases the risk of your baby being born early or being of a very low weight. If you develop symptoms or think there is a chance you may be infected, especially if you are pregnant, see a doctor immediately. The treatment is an oral antibiotic called metronidazole (this is also used to treat BV). Treatment is usually very effective, but it is important to avoid having sex until you complete the course of antibiotics to prevent reinfection occurring.3
There are a number of other conditions that can cause soreness or irritation as well. Some women develop marked discomfort due to a contact irritation from something as simple as a change in washing powder or an allergic reaction to a sanitary product. Skin conditions called lichen planus and lichen sclerosus can cause intense itching too and need medical treatment.
A foreign body, such as a forgotten tampon, can also result in a smelly, unpleasant discharge, so it is always worth checking that you remembered to remove the last tampon at the end of your period.
Other infections may well present in a similar way to thrush, including chlamydia or gonorrhoea. If you suspect you may have a sexually transmitted infection, the best course of action is to go down to your local GUM clinic (genitourinary medicine clinic). Here they will be able to counsel you and give you appropriate advice, as well as to screen you for a full range of infections.
What symptoms suggest that I need to see a doctor?
If you are less than 16, over 60, or this is a first time you have ever had what you suspect is thrush, you should go and see your GP. If you suffer from recurrent thrush (two or more episodes in six months) or you have other symptoms suggestive of a different infection, for example discharge of an unusual colour, smell, or of an increased amount, you should also visit your GP. If you are suffering marked pain on urination or have low abdominal pain or a temperature as well, this is not characteristic of thrush and, again, you should go to the doctor.
If during intercourse you have marked discomfort or a blood stained discharge or bleeding please do get reviewed. Bleeding after sex or in-between periods is often a sign of an infection, and, on rare occasions, may be a sign of cancer so it is very important for your doctor to review you as soon as possible. If you develop vaginal or vulval sores, ulcers or blisters this could be a sign of an infection such as herpes so seeing your doctor or GUM clinic is the best course of action.
- BASHH, National guideline on the management of vulvovaginal candidiasis, British Association for Sexual Health and HIV, 2007, https://www.bashh.org/documents/1798.pdf (accessed 11 April 2017).
- NICE, ‘Candida – female genital’, Clinical Knowledge Summaries, National Institute for Health and Clinical Excellence, 2016, https://cks.nice.org.uk/candida-female-genital#!references/1381308 (accessed 11 April 2017).
- FSRH, ‘Management of Vaginal Discharge in Non-Genitourinary Medicine Settings’, Clinical Guidance, Faculty of Sexual and Reproductive Healthcare, 2012, https://www.bashh.org/documents/4264.pdf (accessed 11 April 2017).
- NICE, ‘Bacterial vaginosis’, Clinical Knowledge Summaries, National Institute for Health and Clinical Excellence, 2014, https://cks.nice.org.uk/bacterial-vaginosis (accessed 11 April 2017).