Executive summary
- Typical: vulval itch/soreness ± dysuria, dyspareunia, erythema; discharge may be thick/curdy or minimal.
- Non-pregnant: fluconazole 150 mg stat or clotrimazole pessary 500 mg stat.
- Pregnancy: avoid oral fluconazole; use topical azole for up to 7 days.
Diagnosis and differentials
- BV (fishy odour, thin discharge), STI/cervicitis (bleeding/pelvic pain), dermatitis/lichen sclerosus (persistent itch + skin changes).
- Consider swab if recurrent, atypical, or treatment failure.
Treatment and recurrence
- Add topical azole cream externally if needed; advise on irritants and condom compatibility with some creams.
- Recurrent (often ≥4/year): confirm diagnosis, assess triggers (diabetes, antibiotics, immunosuppression) and consider specialist suppression regimen if confirmed.
Safety-net / referral
- Review if pelvic pain, fever, foul discharge, bleeding, vulval skin changes, or persistent/recurrent symptoms.
- Consider sexual health or gynae referral if diagnostic uncertainty or refractory disease.
Frequently asked questions
Should partners be treated?
Not routinely for uncomplicated thrush; treat partner balanitis if symptomatic.
Is oral fluconazole safe in pregnancy?
Avoid oral fluconazole in pregnancy; use topical azoles.
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.