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Thrush or herpes?

How should I treat thrush (candida), when I have genital herpes?

Thrush is also known as candidiasis or a yeast infection.

It is widely thought that that using a thrush cream to treat a yeast infection can make a genital herpes outbreak worse. So if you have both at once, it is best to use a pill (oral medication) to get rid of thrush: you can buy fluconazole pills (brand name Difflucan or Canesten) at the chemist or it can be prescribed by your doctor. One dose should be enough.Woman taking a thrush pill

First of all, it may be an idea to make sure that thrush is actually what you have. American studies show that two-thirds of women who buy over-the-counter thrush treatments don’t have a yeast infection at all.

Problems may also be caused by ‘jock itch’ – another itchy rash, often in the groin area that is usually caused by fungus infections called tinea. It is treated with anti-fungal cream, but tablets are sometimes used.

What is thrush like?

In women, the symptoms usually start with itch all over the vulva – the outside part of the genitals. If not treated, it can become painful and swollen. You might notice a thick, white ‘cottage cheese’ discharge – or a thin, watery white one.

In men, skin in the genital area may be sore and itchy, particularly under the foreskin.

How to tell the difference between a herpes outbreak and thrush?

Typically, a recurrence of genital herpes is one-sided, that means you will have the symptoms only on the left (or the right) not spread across the whole area. And a recurrence of genital herpes will cover an area of less than a 50p piece. Itch may be a symptom, but not necessarily. No discharge.

Thrush affects the whole area – and the itch is the main symptom you will notice, along with the white discharge. This white discharge is what gives the fungus its medical name of Candida albicans.

More about thrush

It is common. It is a fungus that lives with us. Virgins can get it. It can be treated but it is ‘incurable’. (And I use ‘incurable’ in the sense that our bodies can deal with it, but there is no medication to remove it completely so it can ‘just come back’.)

Although you don’t catch it in the first place (you just ‘develop it’), it is possible to pass thrush to a partner and (if he or she is not treated) you can catch it back again. So sexual health clinics will give you treatment for your partner to take at the same time. Men tend to be affected by thrush less than women, but along with jock itch it can cause problems for people who work in fixed positions for long periods without the opportunity for exercise and air circulation – such as lorry and bus drivers. Both infections prefer warm, damp environments, so loose fitting clothes and cotton underwear that breathes are best. Avoid wearing tights in hot weather.

Thrush is one of the many (two dozen or so) differential diagnoses that a well-informed doctor will consider if a swab test for herpes simplex is negative.

You can read a more full account of thrush: Feeling fungal? Not thrush again!