Thrush in men and women

Definition
Thrush is a superficial fungal infection caused predominantly by Candida albicans affecting the genital area in men and women. It leads to inflammation, itching, and discharge.

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Causes

• Overgrowth of Candida albicans due to imbalance of normal flora

• Reduced immunity or changes in local environment

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Risk Factors

• Antibiotic use

• Diabetes mellitus

• Pregnancy

• Immunosuppression (e.g., HIV, steroid use)

• Use of hormonal contraceptives

• Tight or synthetic clothing

• Poor genital hygiene or over-washing with perfumed products

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Clinical Features

In Women

• Vulval itching, soreness, burning

• Thick, white, “cottage cheese-like” vaginal discharge

• Dysuria (burning on urination)

• Dyspareunia (pain during sex)

• Vulval redness, swelling

In Men

• Itching, redness of glans and foreskin (balanitis)

• White patches under foreskin

• Discomfort during urination or intercourse

• Fissuring of foreskin

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Diagnosis

• Clinical examination

• Microscopy and culture of discharge if recurrent or atypical

• Blood glucose testing in recurrent cases (exclude diabetes)

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Treatment

General Measures

• Avoid irritants (perfumed soaps, tight clothing)

• Keep area clean and dry

Pharmacological

Topical antifungals

• Clotrimazole 1% cream – apply 2–3 times daily for 1–2 weeks

• Miconazole 2% cream – apply twice daily for 1–2 weeks

Intravaginal antifungals (for women)

• Clotrimazole 500 mg pessary single dose OR 100 mg pessary nightly for 6 nights

• Miconazole 1,200 mg pessary single dose OR 200 mg pessary nightly for 3 nights

Oral antifungals

• Fluconazole 150 mg single oral dose (adults; avoid in pregnancy unless advised by a specialist)

Sexual partners

• Treat only if symptomatic; routine treatment of asymptomatic partners not required

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Complications

• Recurrent vulvovaginal candidiasis (>4 episodes/year)

• Secondary bacterial infection

• Psychological impact due to discomfort and sexual disturbance

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Quick-Reference Clinical Chart — Thrush in Men and Women

Feature	Women	Men
Main symptoms	Vulval itching, soreness, thick white discharge, burning urination, dyspareunia	Itching/redness of glans/foreskin, white patches, soreness, fissuring
Main cause	Candida albicans	Candida albicans
Risk factors	Antibiotics, pregnancy, diabetes, immunosuppression, hormonal contraceptives	Poor hygiene, diabetes, immunosuppression, antibiotics
First-line treatment	Clotrimazole pessary (500 mg single dose) or cream for 1–2 weeks; fluconazole 150 mg PO single dose	Clotrimazole 1% cream for 1–2 weeks; fluconazole 150 mg PO single dose
Special notes	Avoid scented soaps, wear cotton underwear, check for diabetes if recurrent	Retract foreskin to clean and dry thoroughly, check for diabetes if recurrent