Patient information · Women's health
Thrush and bacterial vaginosis
two different problems, two different treatments
Thrush and bacterial vaginosis are both common and neither is a sexually transmitted infection. They are frequently confused, and treating the wrong one is why so many people cycle through pharmacy products without success. The symptoms that distinguish them are itch and smell.
Arrange assessment rather than self-treating if you have
- pelvic or lower abdominal pain, or pain deep during sex
- a fever, or feeling generally unwell
- bleeding between periods or after sex
- blisters, ulcers or sores
- symptoms during pregnancy, or if you are under 16
- no improvement after one course of appropriate treatment
Pelvic pain with abnormal discharge can indicate pelvic inflammatory disease, which needs prompt treatment to protect future fertility. Discharge with any risk of a sexually transmitted infection should be tested rather than treated blind.
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.
Washing is the commonest thing that makes it worse
The vagina is self-cleaning and maintains its own acidity. Never douche. Do not use soap, shower gel, bubble bath, wipes, feminine washes, deodorants or perfumed products in or around the vulva — all of them strip the natural balance and are a leading cause of recurrent BV and irritation. Wash the vulva with water only, or a plain emollient, once a day.
Reducing recurrence
Helps
- Cotton underwear, and none at night
- Washing with water or a plain emollient only
- Wiping front to back
- Changing out of wet swimwear and gym kit promptly
- Non-biological detergent, well rinsed
Makes it worse
- Douching, feminine washes and scented products
- Tight synthetic clothing worn all day
- Bubble bath and heavily perfumed bath products
- Panty liners worn continuously
- Over-washing — more than once a day
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.
Book an appointment if symptoms have not settled after one treatment, they keep coming back, you are pregnant, or there is any chance of a sexually transmitted infection. We offer discreet women's health appointments, swabs and full sexual health screening on site, seven days a week.
Discreet testing, results without a wait
Women's health and sexual health appointments seven days a week on Whitechapel Road.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.