Genital thrush medications

There are a variety of creams and pessaries available in Aotearoa New Zealand. They come in different strengths and should be used for the amount of time specified on the directions for use. A single large dose is often enough to clear a bout of thrush. Otherwise a lower dose is used for several days. 

• Creams come as a tube of cream together with special applicators that you need to fill with the cream. The applicator is used to measure the right dose of cream and enables insertion of cream inside your vagina or onto your penis. Examples of vaginal creams include Clomazol®, Canesten®, Micreme® and Nilstat®.
• Vaginal pessaries are compressed and moulded into a tablet that is inserted into your vagina with a special applicator, or they can be inserted carefully by hand. Examples of vaginal pessaries include Canestan®.

Creams and vaginal pessaries are best applied at night, before bed. There are directions inside the packet and your pharmacist will explain to you how to use them.

Sometimes an antifungal cream can be applied to the opening of your vagina and surrounding area (called the 'vulva'). This may ease itching and clear infection on the outside of your vagina. This may be suitable in mild cases, or for girls under the age of 16 years. Ask your doctor or pharmacist for advice about these creams. 

Fluconazole capsules can be prescribed for thrush. These work just as well as the creams and vaginal pessaries but relief can be more rapid.

• The dose is a 150 mg capsule taken once, as a single dose, with a glass of water (200–250 mLs). 
• The capsule can be taken with or without food.
• Fluconazole 150 mg capsule can be bought from your pharmacy without a prescription, after discussion with your pharmacist.
• If your doctor has prescribed fluconazole for recurrent candidiasis, you will need to take fluconazole for a few months. It is important to take your medicine regularly to make sure the infection clears up properly.

There are a few combination antifungal products available. These include: 

• Canesoral Duo®: fluconazole capsule + clotrimazole cream (the capsule treats the infection and the cream relieves discomfort).
• Canesten®: clotrimazole pessary + clotrimazole cream (the pessary treats the infection and the cream relieves discomfort).

The choice of antifungal medicines depends on a number of things. Your doctor or pharmacist will discuss the best option for you. The following are examples of the sorts of things to consider.

• If you are female, whether you are pregnant: Fluconzaole is not recommended for use in pregnancy or if you are planning a pregnancy. Pregnant woman can use the vaginal cream but take care when inserting the vaginal cream using an applicator so that there is no contact with the cervix. Some women may prefer to use vaginal pessaries (without applicator) to avoid any risk.
• How often you get thrush: Over-the-counter products may not be adequate if the infection occurs frequently. Read more about recurrent vaginal thrush. 
• Whether you use latex condoms or diaphragms: Creams and pessaries can damage them and make them less reliable.
• Whether you are taking other medicines: Some medicines may interact with some antifungal products.  
• Your age: If you are under the age of 16 or over 60, ask your doctor for advice.
• Your preference: Some people may find using the cream or pessary messy and uncomfortable.
• Side effects: The cream and pessaries can cause irritation of your vagina or penis, such as redness, itch and swelling. Fluconazole can cause nausea (feeling sick) and headache.
• Interactions: fluconazole can interact with some medicines, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting fluconazole and before starting any new products.

If you have recurrent thrush (more than 4 times in a year) it is best to see your doctor for further advice. Your doctor may prescribe antifungal medication that needs to be used for a longer time.  

If you still have thrush symptoms a week after starting treatment then see your doctor or nurse. Treatment does not clear symptoms in up to 1–5 cases. If so, your thrush could be due to a different condition or you may have a quick recurrence of a new thrush infection.

There is no evidence that taking or using Lactobacillus acidophilus (or other probiotics) will help treat thrush. There is, however, no evidence of harm with their use. Using a probiotic alongside antifungal treatment for thrush may help control the condition in the short term, but not necessarily for recurrent thrush. Read more about probiotics.