Private thrush & bacterial vaginosis clinic in London, same-day women's health.

Telling them apart

• Thrush — the dominant symptom is itching, with soreness, stinging on passing urine, and a thick white discharge often described as cottage cheese. It generally does not smell.
• Bacterial vaginosis — the dominant symptom is smell, characteristically fishy and worse after sex or around a period, with a thin, watery, greyish-white discharge. It is usually not itchy.
• Trichomonas — frothy yellow-green discharge with soreness and smell. This one is sexually transmitted and needs testing and partner treatment.
• A normal amount of clear or white discharge that changes through the cycle is healthy and needs no treatment at all.

Treating thrush

• An antifungal pessary or internal cream, or a single antifungal tablet — both work equally well. Tablets are avoided in pregnancy.
• An external antifungal cream for the itch alongside, if needed.
• Antifungal creams can damage latex condoms and diaphragms — use additional contraception for five days.
• Symptoms should settle within a few days. If nothing has changed after a week, it is probably not thrush.

Treating bacterial vaginosis

• A course of antibiotic tablets or vaginal gel, prescribed after assessment.
• Avoid alcohol with certain of these antibiotics and for 48 hours afterwards — the reaction is genuinely unpleasant.
• BV in pregnancy is associated with preterm birth, so it should be treated rather than tolerated.
• It commonly recurs; discuss longer courses or maintenance treatment if it does.

Reducing recurrence

Recurrent infections

Four or more episodes of thrush in a year, or BV that keeps returning, is worth investigating rather than treating repeatedly. We would confirm the diagnosis with swabs, check for diabetes, review contraception and any medicines, and consider a longer maintenance regimen. Recurrent thrush is sometimes the first presentation of undiagnosed diabetes.