Vaginal thrush (candidiasis)
Also called: vaginal yeast infection, vulvovaginal candidiasis, VVC, candida vaginitis, yeast infection
Vaginal thrush is a common yeast infection of the vagina and vulva, usually caused by Candida albicans. It causes itching, soreness and a thick white discharge. It is not a sexually transmitted infection, and antifungal pessaries, creams or tablets usually clear it.
General health information for Pakistan. It does not give doses or brand advice. If you are worried, or symptoms are severe, see a doctor. When to see a doctor
Overview
Vaginal thrush (vulvovaginal candidiasis) is an infection caused by a yeast, a type of fungus called Candida. Small amounts of Candida live harmlessly in the vagina, mouth, gut and on the skin of many people. Thrush happens when the yeast grows too much and upsets the normal balance of germs in the vagina. The vulva is the skin outside the vagina, and it is often itchy and sore too.
Thrush is very common. About three in four women have at least one episode in their life, and many have more than one. It is not classed as a sexually transmitted infection (STI), although sex can trigger it. Things that make it more likely include antibiotics, pregnancy, diabetes that is not well controlled and a weak immune system. Many women get it with no clear trigger at all.
Most cases are mild and clear with a short course of antifungal medicine placed in the vagina or taken by mouth. Complicated thrush is different: it is severe, keeps coming back, is caused by less common types of Candida, or happens in someone with diabetes or a weak immune system. It needs a longer course and tests. Because other infections can look the same, a first episode or one that does not settle should be checked by a doctor or nurse.
In Pakistan
A study of women with vaginal symptoms at a Peshawar hospital found Candida in 43 percent, with non-albicans types making up more than half, and very high resistance to fluconazole and vaginal azoles, which the authors linked to overuse of these medicines. This is a reason to get a swab test when thrush does not clear, rather than repeating the same treatment.
Symptoms
- Itching and irritation of the vulva and vagina
- Thick, white vaginal discharge that looks like cottage cheese and usually does not smell; sometimes the discharge is thin and watery
- Soreness of the vagina
- Stinging or burning when passing urine, felt on the skin outside
- Pain or discomfort during sex
- Redness and swelling of the vulva, sometimes with small cracks or scratch marks in the skin
- Some women with Candida in the vagina have no symptoms at all
Causes and risk factors
Causes
- Overgrowth of Candida albicans, a yeast that normally lives in small numbers in the vagina
- Less often, other Candida species (non-albicans types such as Candida glabrata or Candida krusei), which can be harder to treat
- A change in the balance of normal vaginal germs, for example after a course of antibiotics
- Warm, moist conditions and irritated or damaged skin, which help the yeast grow
What makes it more likely
- Taking antibiotics, especially frequent courses
- Pregnancy
- Diabetes, particularly when blood sugar is poorly controlled
- A weakened immune system, for example from HIV, chemotherapy or steroid medicines
- Hormone replacement therapy (HRT)
- Obesity
- Tight underwear or clothing made of nylon or silk, and staying in wet or sweaty clothes
- Using soaps, shower gels, douches (washing inside the vagina) or perfumed products on the genital area
Complications
Thrush is usually harmless, but it can be very uncomfortable. Scratching can crack the skin and let bacteria in, causing a skin infection. A small number of women get recurrent thrush, usually defined as three or more episodes in a year, which can affect sex, sleep and daily life; long-term treatment controls it but rarely cures it for good. Severe thrush and thrush caused by less common Candida types respond less well to short treatment. Thrush that keeps coming back or does not respond can be a sign of diabetes or a weak immune system. Thrush has also been linked with a higher chance of catching HIV. Oil-based antifungal creams and pessaries can weaken latex condoms and diaphragms, so contraception may fail.
When to see a doctor
- Pain low in the belly (pelvic pain) or a fever along with vaginal symptoms: see a doctor rather than treating yourself
- Thrush-like symptoms while pregnant or breastfeeding, so the doctor or midwife can choose a safe treatment
- Symptoms that do not clear after treatment, get worse, or come back within two months
- Thrush more than four times in a year
- New or different symptoms, or a chance you may have caught a sexually transmitted infection
- Symptoms for the first time, or in a girl under 16 or a woman over 60
- Thrush in someone with diabetes, HIV or another cause of a weak immune system
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Diagnosis
A doctor or nurse can often suspect thrush from the symptoms and by looking at the vulva and vagina, which may be red and swollen with a thick white discharge. Because the symptoms are not specific to thrush, testing is recommended, especially the first time. A swab of the discharge is looked at under a microscope, often with a chemical called potassium hydroxide (KOH) that makes yeast easier to see. The vaginal pH (acidity) is usually normal in thrush, which helps tell it apart from other infections such as bacterial vaginosis.
If the microscope test is negative but symptoms suggest thrush, or if thrush keeps coming back or does not respond to treatment, a culture (growing the yeast in the laboratory) is done. Culture is the most reliable test and shows which type of Candida is present. Finding yeast in a woman with no symptoms is not a reason to treat, because many healthy women carry it. In repeated or hard-to-treat thrush, the doctor may also test for diabetes or HIV.
Treatment
- For mild, occasional thrush in a woman who is not pregnant and has had it diagnosed before, a pharmacist can advise an antifungal pessary, vaginal tablet or cream, or a single antifungal tablet by mouth.
- Use the full course even if symptoms improve early. Symptoms usually clear within one to two weeks.
- If this is the first episode, you are pregnant, or symptoms are unusual, see a doctor first so other infections can be ruled out with a swab.
- In pregnancy, only antifungal medicine used inside the vagina is recommended, usually for a longer course. Oral fluconazole is avoided. The doctor or midwife decides the medicine and how long to use it.
- Severe thrush, thrush in someone with diabetes or a weak immune system, and thrush caused by less common Candida types need a longer course; your doctor decides the medicine and the dose.
- For recurrent thrush, the doctor first clears the infection with a longer course, then may give a maintenance (preventive) antifungal for several months, and looks for triggers such as diabetes or frequent antibiotics.
- Sexual partners do not need treatment unless they have symptoms, such as itching or redness of the penis.
Medicines in Pakistan
Medicines a doctor may use, by group. Read the role: some are only for special cases. Each link opens our page for that medicine, with every brand and its official DRAP price. Your doctor decides which medicine and dose are right for you.
| Group | Role | Medicines |
|---|---|---|
| Vaginal azole antifungals | first choice: pessaries, vaginal tablets or creams placed in the vagina; the only recommended type in pregnancy, as a longer course | Clotrimazole (139 brands), Miconazole (53 brands) |
| Oral azole antifungals | a single tablet by mouth is an effective alternative for uncomplicated thrush; also used for severe and recurrent thrush; not used in pregnancy because it has been linked with miscarriage and birth defects | Fluconazole (217 brands) |
| Polyene antifungals | vaginal tablets used as a substitute for azoles, or when symptoms persist despite usual treatment | Nystatin (17 brands) |
Also used (not yet in our price list): tioconazole (a vaginal azole antifungal), boric acid vaginal capsules (used under specialist advice for repeated thrush caused by less common Candida types)
Self-care and prevention
Self-care
- Wash the genital area with plain water and an emollient (a moisturising cream used as a soap substitute) instead of soap
- Dry the area well after washing
- Wear loose cotton underwear and avoid tight underwear or tights
- Do not use douches, deodorants, perfumed sprays or powders on or inside the vagina
- Avoid sex until thrush clears if it is uncomfortable, and remember that antifungal creams can damage condoms and diaphragms
- Do not use over-the-counter thrush treatment more than twice in six months without talking to a pharmacist or doctor
- Change out of wet swimwear or sweaty exercise clothes promptly
Prevention
- Keep the genital area clean and dry, using water rather than soap
- Wear cotton underwear and loose clothing
- Avoid douching and perfumed products on the genital area
- Keep blood sugar well controlled if you have diabetes
- Use antibiotics only when a doctor prescribes them
- Use condoms to lower the risk of other infections
Common questions
Is vaginal thrush a sexually transmitted infection?
No. Thrush is caused by a yeast that normally lives in the body, and it is not classed as an STI. Sex can trigger it, and occasionally it can pass to a partner, but partners only need treatment if they have symptoms.
Can I treat thrush myself?
If you have had thrush diagnosed before, recognise the symptoms, are not pregnant and have no pelvic pain or fever, a pharmacist can advise treatment. See a doctor if it is your first time, if treatment does not work, or if it keeps coming back. Repeated self-treatment without a test can miss other infections.
Is it safe to treat thrush in pregnancy?
Thrush is common in pregnancy and can be treated. Guidelines recommend medicine placed in the vagina, and the tablet fluconazole is avoided because it has been linked with miscarriage and birth defects. Always let your doctor or midwife choose the treatment.
Why does my thrush keep coming back?
Some women get thrush three or more times a year. It can be linked to frequent antibiotics, diabetes or a weak immune system, but often no cause is found. A doctor can confirm it with a swab and culture and may offer a longer preventive course.
Should my husband be treated too?
Usually not. Treating a partner who has no symptoms does not help. If he has itching, redness or soreness of the penis, he can be treated for his own symptoms.
Sources
- CDC. Vulvovaginal Candidiasis - STI Treatment Guidelines (n.d.).
- WHO (NCBI Bookshelf). Table 4, Treatment options for vaginal infections - Guidelines for the management of symptomatic sexually transmitted infections - NCBI Bookshelf (2021).
- CDC. Treatment of Candidiasis | Candidiasis | CDC (n.d.).
- NHS. Thrush in men and women - NHS (2023).
- MedlinePlus. Vaginal yeast infection: MedlinePlus Medical Encyclopedia (n.d.).
- Pakistan Journal of Medical Sciences (PMC). Azoles resistance of candida species causing vulvo-vaginitis in reproductive age women at a tertiary care setting (2022).
Prepared from the sources listed below by the MedInfoBase team. Last reviewed 16 October 2026. This page is general health information, not medical advice. It gives no doses and does not replace a doctor: talk to your doctor or pharmacist before starting, stopping or changing any medicine. How we write and check our pages.
Related conditions
Bacterial vaginosisType 2 diabetes mellitusUrinary tract infection (UTI)