Genital Candidiasis (Genital Thrush)

Comments from Expert Advisory Group

1. Candida can lead to genital symptoms in men and women. Asymptomatic colonisation is common and does not usually require treatment. The majority of cases are caused by Candida albicans.
2. In women, genital candidiasis can lead to vulvitis, vaginitis and / or vulvovaginitis. Symptoms may include thick white vaginal discharge, vulvovaginal discomfort, burning or itch. Other symptoms include dyspareunia / dysuria and signs include vulval erythema / fissuring and satellite lesions.The diagnosis can be made clinically on the basis of the description and appearance of the vulva and/or vaginal discharge. A high vaginal swab (HVS) is not required to start empiric treatment on first presentation.  A HVS can be useful in women experiencing recurrent symptoms or failing to respond to treatment in order to confirm the presence of candida, the type of candida species and sensitivities where resistance to azoles is suspected.
3. All women should be examined and alternative diagnoses including genital dermatoses should be considered. Consider atrophic vaginitis, which is a common symptom of the perimenopause and menopause and can also occur several years after the menopause.
4. In women, consider sexually transmitted causes of vaginal discharge on the basis of sexual history and consider testing for chlamydia, gonorrhoea and trichomoniasis.
5. The definition of recurrent vulvovaginal candidiasis is accepted as four or more episodes per year, two of which are confirmed on microscopy or culture when symptomatic. Careful consideration should be given to alternative diagnoses such as lichen sclerosis, eczema or other dermatological conditions. Referral to Genitourinary Medicine or Dermatology may be warranted. The  vulval skin care leaflet from the British Association of Dermatology contains general advice for patients.
6. In men, genital candidiasis can present with a balanitis with an associated itch. Men should be examined and the diagnosis can be made by the appearance of the glans penis. Examination is particularly important if symptoms don’t resolve and alternative diagnoses should be considered.
7. Identify and optimise the management of underlying conditions or risk factors for genital thrush such as undiagnosed or poorly controlled diabetes. Consider underlying immunosuppression in those presenting with severe, recurrent cases.
8. In general, treatment of asymptomatic sexual partners is not recommended.
9. Repeated single doses of fluconazole increase the likelihood of azole resistance and should be avoided where possible. Provision of a prescription for single dose fluconazole with a course of antibiotics “just in case” is generally not recommended.

Treatment Options

• Good genital skin care is central to the management and prevention of genital candidiasis, particularly vulvovaginal candidiasis. This includes avoidance of soap and shower gel and other potential irritants. Emollient creams may be used as a soap substitute, moisturiser and/or barrier cream (external use only). The  vulval skin care leaflet from the British Association of Dermatology contains general advice for patients.
• Intravaginal and oral treatments have similar efficacy in the management of vulvovaginal candidiasis.  
• 1% hydrocortisone with antifungal cream may ease symptoms of vulvitis and balanitis.
• Atopic individuals may experience irritation with antifungal creams. Symptoms may settle with intravaginal antifungal treatment alone.

There are many treatment options available, the table below is not exhaustive.

 * Women of childbearing potential, for whom fluconazole is prescribed, should be informed of the potential risks to the foetus:

• After single dose treatment, a washout period of one week is recommended before pregnancy.
• For longer courses of treatment appropriate contraception should be considered throughout the treatment period and for one week after the final dose.

Patient Information

Strategies to prevent recurrence of genital thrush include:

• Use emollient cream as a soap / shower gel substitute for daily genital hygiene.
• Avoid vaginal douching and the use of other feminine hygiene products.
• Avoid the use of sanitary pads and pantyliners; tampons or menstrual cups are preferred.
• Avoid tight clothes, favour loose and breathable fabrics like cotton.
• Use water-based lubricant during sexual intercourse.
• The vulval skin care leaflet from the British Association of Dermatology contains general advice for patients.
• Further information is available in the genital thrush patient information leaflet.
• Patient information on STIs and genital conditions is available at the HSE Sexual Health Programme website.

Safe Prescribing

Visit the safe prescribing page

• Doses are oral and for adults unless otherwise stated
• Renal impairment dosing table
• Safety in Pregnancy and Lactation
• Drug interactions tables
• Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed April 2024, minor update March 2025, November 2025