Thrush is caused by an overgrowth of a yeast called Candida - most commonly Candida albicans. This yeast is naturally present throughout the body, including the mouth, gut, and vagina, where it normally causes no problems. When something disrupts the balance of the 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. Both share the same underlying cause but they affect different parts of the body, produce different symptoms, and are treated with different medications. Understanding those differences is important for choosing the right treatment.
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What Is Vaginal Thrush?
Vaginal thrush (also called vulvovaginal candidiasis) is a fungal infection of the vagina and the surrounding area. It's very common: around three in four women will experience at least one episode during 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 is not a sexually transmitted infection, though it can occasionally be passed to a partner during sex.2 Symptoms tend to worsen if left untreated.
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, and it's more frequently seen in babies, older adults, people who wear dentures, and people with conditions that weaken immune function.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 is not considered contagious in most circumstances. The white patches can often be wiped away, leaving behind red areas that may bleed slightly.3
Vaginal Thrush vs Oral Thrush: A Summary of the Differences
Although both conditions are caused by Candida overgrowth, they differ in several important ways:
- Location: Vaginal thrush affects the vagina and vulva; 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 altered 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 antibiotic use, but oral thrush is also strongly linked to inhaled corticosteroids (used for asthma) and poor denture hygiene.
- Treatment: Vaginal thrush is primarily treated with fluconazole or clotrimazole. Oral thrush is primarily treated with miconazole gel (such as Daktarin) or nystatin.
What Causes Each Type of Thrush?
Both types of thrush occur when Candida grows unchecked, but the factors that trigger this vary slightly depending on where the infection develops.
Shared triggers for both types:
- Antibiotic use, which reduces the healthy bacteria that keep Candida in check
- Conditions that weaken immune function, including diabetes and HIV
- Being unwell or run down
Additional triggers for vaginal thrush:
- Hormonal changes, including those associated with pregnancy, the menstrual cycle, and some forms of hormonal contraception
- Wearing tight or non-breathable clothing
- Use of fragranced soaps or shower gels in the vaginal area
Additional triggers for oral thrush:
- Using an inhaled corticosteroid (for asthma) without rinsing the mouth afterwards
- Wearing ill-fitting or poorly cleaned dentures
- Poor oral hygiene
- Very dry mouth (xerostomia)
- Deficiencies in iron, folate, or vitamin B12 3
How Is Vaginal Thrush Treated?
Vaginal thrush responds well to antifungal treatment. 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 a systemic antifungal that works by disrupting the Candida cell membrane, inhibiting an enzyme needed for ergosterol production.2 Most people notice improvement within 24 to 48 hours.
Fluconazole should not be taken during pregnancy. It's also not suitable for anyone taking cisapride, pimozide, quinidine, or erythromycin, or for those who've had thrush more than twice in six months without seeing a doctor.2
Clotrimazole (pessary or cream)
Clotrimazole is an antifungal applied directly to the site of infection. It's available as a vaginal pessary, an intravaginal cream, or an external cream for the vulva. These are a good option for women who'd prefer not to take an oral treatment, and they're the preferred choice during pregnancy.1
A Cochrane review of 26 studies involving over 5,000 women found that oral and intravaginal antifungal treatments were similarly effective for symptom resolution in both the short and longer term.4
How Is Oral Thrush Treated?
Oral thrush is treated with antifungal medicines applied directly to the mouth. Most cases in otherwise healthy adults resolve within a week to two weeks with treatment.
Miconazole oral gel (Daktarin)
Daktarin Oral Gel contains 20mg of miconazole per gram of gel. It's applied to the affected areas inside the mouth four times daily, after meals. The gel should be held in the mouth for as long as possible before swallowing to allow contact with the infected tissue.5
Miconazole is the first-line treatment for oral thrush in adults and in children over four months of age. It's available without a prescription and begins to relieve symptoms within a few days.
One important note: Daktarin Oral Gel must not be used by anyone taking warfarin or other anticoagulants, as miconazole significantly increases the anticoagulant effect, which can cause serious bleeding.5 If you take warfarin, speak to your GP before using this product.
Nystatin liquid
Nystatin is an antifungal suspension available on prescription. It's held in the mouth before swallowing, and is typically used four times a day. It's a common alternative for people who cannot use miconazole.
Fluconazole tablets
In more severe or persistent cases of oral thrush, a GP may prescribe oral fluconazole tablets at a higher dose than that used for vaginal thrush. This is a second-line option for adults.3
Can You Have Both at the Same Time?
Yes, it's possible to have both vaginal thrush and oral thrush at the same time, particularly during or after a course of antibiotics, or in people whose immune system is under strain. This is because the same Candida species can overgrow in multiple sites simultaneously when the body's natural defences are disrupted.
If you develop symptoms in both areas at once, seek advice from a pharmacist or GP rather than self-treating, as the treatment approach for each site is different and it's worth ruling out any underlying factor that might be allowing Candida to take hold more broadly.
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
- Bouchier D, et al. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database of Systematic Reviews. 2021;(4):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.