Thrush is caused by an overgrowth of a yeast called Candida, most often Candida albicans. This yeast lives naturally all over your body, including your mouth, gut and vagina, where it usually causes no problems.
But when something upsets the balance of your body's natural microbes, Candida can multiply and cause an infection.
Vaginal thrush and oral thrush are the two most common forms of Candida infection. They have the same underlying cause, but they affect different parts of your body, cause different symptoms and are treated with different medicines. Knowing the difference matters when it comes to choosing the right treatment.
Same yeast, different treatments. A vaginal thrush treatment won't work for oral thrush, and vice versa.
What is vaginal thrush?
Vaginal thrush (also called vulvovaginal candidiasis) is a fungal infection of the vagina and the area around it. It's very common: around three in four women will have it at least once in their lifetime.1
Typical symptoms include:
- Itching, soreness, or burning around the vagina and vulva
- A thick, white discharge that looks similar to cottage cheese and is usually odourless or has a mild yeasty smell
- Redness and swelling of the vulva
- Discomfort or pain during sex or when passing urine
Vaginal thrush isn't a sexually transmitted infection, though it can occasionally be passed to a partner during sex.2 Symptoms tend to get worse if it isn't treated.
Discharge that's grey or green, or has a strong fishy smell? That may not be thrush, so get it checked.
What is oral thrush?
Oral thrush (also called oropharyngeal candidiasis) is a fungal infection of the mouth. It's less common than vaginal thrush in otherwise healthy adults. It's seen more often in babies, older adults, people who wear dentures and people with conditions that weaken the immune system.3
Typical symptoms include:
- White patches or plaques on the tongue, inner cheeks, gums, or roof of the mouth
- Soreness or a burning sensation inside the mouth
- A loss of taste or an unpleasant taste
- Redness inside the mouth and throat
- Cracks at the corners of the mouth
Unlike vaginal thrush, oral thrush in adults usually isn't considered contagious. The white patches can often be wiped away, leaving red areas that may bleed slightly.3
Use a steroid inhaler? Rinse your mouth with water after each use to help prevent oral thrush.
Vaginal thrush vs oral thrush: a summary of the differences
Both are caused by Candida overgrowth, but they differ in several important ways:
- Location - vaginal thrush affects the vagina and vulva, while oral thrush affects the mouth and throat.
- Symptoms - vaginal thrush causes itching, discharge and soreness in the genital area. Oral thrush causes white patches, soreness and changes in taste in the mouth.
- Who it affects - vaginal thrush mainly affects women of reproductive age. Oral thrush is more common in babies, older adults, denture wearers and people with weakened immunity.
- Triggers - both can follow antibiotics, but oral thrush is also strongly linked to steroid inhalers (used for asthma) and poor denture hygiene.
- Treatment - vaginal thrush is mainly treated with fluconazole or clotrimazole. Oral thrush is mainly treated with miconazole gel (such as Daktarin) or nystatin.
What causes each type of thrush?
Both types of thrush happen when Candida grows unchecked. But what triggers this varies a little depending on where the infection develops.
Shared triggers for both types:
- Antibiotics, which reduce the healthy bacteria that keep Candida in check
- Conditions that weaken the immune system, including diabetes and HIV
- Being unwell or run down
Extra triggers for vaginal thrush:
- Hormonal changes, including during pregnancy, around your period and with some types of hormonal contraception
- Tight or non-breathable clothing
- Using fragranced soaps or shower gels around the vagina
Extra triggers for oral thrush:
- Using a steroid inhaler (for asthma) without rinsing your mouth afterwards
- Dentures that don't fit well or aren't cleaned properly
- Poor oral hygiene
- A very dry mouth (xerostomia)
- Low levels of iron, folate or vitamin B12
Skip fragranced soaps and shower gels around your vagina. Plain water or an emollient is much gentler.
How is vaginal thrush treated?
Vaginal thrush responds well to antifungal treatment, and most cases clear within a week. The main options are:
Fluconazole (oral capsule)
Fluconazole is taken as a single 150mg capsule by mouth. It's an antifungal that works throughout your body, disrupting the Candida cell membrane by blocking an enzyme it needs to make a substance called ergosterol.2 Most people notice an improvement within 24 to 48 hours.
Fluconazole shouldn't be taken during pregnancy. It also isn't suitable if you take cisapride, pimozide, quinidine or erythromycin, or if you've had thrush more than twice in six months without seeing a doctor.2
Clotrimazole (pessary or cream)
Clotrimazole is an antifungal you apply directly where the infection is. It comes as a vaginal pessary, a cream you put inside the vagina, or an external cream for the vulva. These are a good choice if you'd rather not take a tablet, and they're the preferred option during pregnancy.1
A Cochrane review of 26 studies involving over 5,000 women found that oral and vaginal antifungal treatments worked about equally well for clearing symptoms, in both the short and longer term.4
Pregnant or think you might be? Do not take fluconazole. Speak to a pharmacist or GP about a cream or pessary instead.
How is oral thrush treated?
Oral thrush is treated with antifungal medicines applied directly in the mouth. In otherwise healthy adults, most cases clear within one to two weeks with treatment.
Miconazole oral gel (Daktarin)
Daktarin Oral Gel contains 20mg of miconazole per gram of gel. You apply it to the affected areas inside your mouth four times a day, after meals. Keep the gel in your mouth for as long as possible before swallowing, so it stays in contact with the infected area.5
Miconazole is the first-line treatment for oral thrush in adults and in children over four months old. It's available from pharmacies without a prescription and usually starts easing symptoms within a few days.
One important point: Daktarin Oral Gel shouldn't be used if you take warfarin or another blood thinner, unless your doctor is closely monitoring you. Miconazole can greatly increase the effect of these medicines, which can cause serious bleeding.5
Do not put Daktarin gel at the back of a baby's throat. Small amounts at the front of the mouth lower the choking risk.
Nystatin liquid
Nystatin is an antifungal liquid available on prescription. You hold it in your mouth before swallowing, usually four times a day. It's a common alternative if you can't use miconazole.
Fluconazole tablets
For more severe or persistent oral thrush, a GP may prescribe fluconazole tablets, as a course rather than the single dose used for vaginal thrush. This is a second-line option for adults.3
Can you have both at the same time?
Yes. You can have vaginal and oral thrush at the same time, especially during or after a course of antibiotics, or if your immune system is under strain. That's because the same Candida can overgrow in more than one place at once when your body's natural defences are disrupted.
Symptoms in both areas at once? Get advice from a pharmacist or GP rather than treating yourself. Each area needs a different treatment, and it's worth ruling out anything underlying that might be letting Candida take hold more widely.
When to seek further advice
Speak to a pharmacist or GP if:
- You're experiencing thrush symptoms for the first time and you're not certain of the diagnosis
- Symptoms do not improve within a week of starting treatment
- You've had thrush more than twice in the past six months
- You're pregnant or think you may be pregnant
- You're taking warfarin or another anticoagulant and need oral thrush treatment
- You have oral thrush alongside symptoms elsewhere in the body, or you're feeling generally unwell
- You develop severe symptoms, including difficulty swallowing from oral thrush or significant pelvic discomfort from vaginal thrush
Frequently asked questions
What's the difference between vaginal thrush and oral thrush?
Both are caused by an overgrowth of the yeast Candida albicans, but they affect different parts of the body. Vaginal thrush develops in the vagina and vulva, causing itching, soreness, and a thick white discharge. Oral thrush develops in the mouth and throat, causing white patches, soreness, and an altered sense of taste. They're treated differently too: vaginal thrush is usually treated with fluconazole or clotrimazole, while oral thrush is primarily treated with miconazole gel (such as Daktarin) or nystatin.
Is oral thrush contagious?
Oral thrush in adults is not generally considered contagious. Candida is naturally present in most people's mouths without causing problems, and oral thrush develops when that balance is disrupted rather than being passed between people. That said, it can occasionally spread through direct contact, such as kissing, particularly if one person's immune system is weakened. If you have oral thrush, it's worth avoiding sharing utensils or cups until the infection has cleared.
What causes vaginal thrush?
Vaginal thrush occurs when Candida, which is normally present in the vagina in small amounts, grows unchecked. Common triggers include antibiotics (which reduce the bacteria that keep* Candida* under control), hormonal changes associated with pregnancy or the menstrual cycle, diabetes, wearing tight or non-breathable clothing, and using fragranced soaps or shower gels in the vaginal area. Some people are more prone to thrush than others without a clear identifiable cause.
Does vaginal thrush go away on its own?
Vaginal thrush can occasionally clear without treatment, but it's unlikely to do so quickly and symptoms often worsen in the meantime. Antifungal treatment resolves most cases within a week. If you've had thrush before and you're confident in the diagnosis, over-the-counter treatment with fluconazole or clotrimazole is appropriate. If symptoms don't improve within a week of starting treatment, or if this is your first episode and you're not certain of the diagnosis, speak to a pharmacist or GP.
How long does oral thrush last?
With treatment, oral thrush in adults usually clears within one to two weeks. Without treatment, it's unlikely to resolve on its own and symptoms may worsen or spread. If your symptoms haven't improved after a week of using an antifungal treatment such as Daktarin Oral Gel, see your GP, as you may need a different or longer course of treatment.
Can you use fluconazole for oral thrush?
Fluconazole can be used for oral thrush, but it's not the first-line treatment in most cases. For mild to moderate oral thrush in adults, miconazole gel (Daktarin) or nystatin suspension are usually tried first. Fluconazole is typically prescribed by a GP for more severe or persistent cases, and at a higher dose than the 150mg single-dose capsule used for vaginal thrush. If you're unsure which treatment is right for you, speak to a pharmacist.
Can you have vaginal thrush and oral thrush at the same time?
Yes, it's possible. Both types are caused by the same Candida species, and when the body's natural defences are disrupted, such as during or after a course of antibiotics, Candida can overgrow in multiple sites simultaneously. If you develop symptoms in both areas at once, seek advice from a pharmacist or GP rather than self-treating, as each type requires a different treatment and it's worth ruling out an underlying reason why Candida is taking hold more broadly.
References
- Vulvovaginal Candidiasis. NICE Clinical Knowledge Summary. Updated 2023. cks.nice.org.uk/topics/candida-female-genital
- Fluconazole 150mg Capsules, Patient Information Leaflet. Electronic Medicines Compendium (eMC). Reviewed 2023. medicines.org.uk/emc/product/4438/pil
- Oral Thrush in Adults. NHS Inform. Reviewed 2023. nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/oral-thrush-in-adults
- Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database of Systematic Reviews. 2020;(8):CD002845. doi:10.1002/14651858.CD002845.pub3
- Daktarin Oral Gel, Summary of Product Characteristics. Electronic Medicines Compendium (eMC). medicines.org.uk/emc/product/14746/smpc
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.