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Conditions mistaken for thrush

Confused for thrush

By Lauren Gibbons

Thrush is a common vulvovaginal condition - affecting roughly 75% of women at one point in their lifetime (NICE 2023) - but the fungal infection's symptoms can frequently overlap with a host of other health issues.

In fact, multiple studies show that self-diagnosis of thrush is notoriously unreliable. So, being able to distinguish between the various conditions that mimic thrush is a useful tool to have in your locker. However, if there is any doubt or symptoms persist, contact your healthcare provider.

Lichen sclerosus (LS)

Lichen sclerosus - a chronic inflammatory skin condition - can often masquerade as thrush because it causes intense vulval itching and stinging.

Thrush and LS differ as LS typically causes the skin around the vulva and anus to turn pale or chalky white, thin out, or look like crinkled ‘tissue paper’.

Unlike thrush, LS does not cause vaginal discharge. Over time, LS can cause structural changes or tearing around the labia and requires prescription topical steroids. LS is a lot less common than thrush and is estimated to affect around 1 in 100 women in the UK (Lichen Sclerosis Guide).

A diagnosis of LS is usually confirmed by a vulval clinician - find a local consultant here.

Genitourinary syndrome of menopause (GSM)

GSM can impersonate some thrush symptoms, which include vaginal dryness, burning and pain during sex.

GSM is driven by declining estrogen levels during perimenopause and menopause. This hormonal drop thins and dries out the vulvovaginal tissues.

While thrush produces a thick, lumpy discharge, GSM causes dryness, watery discharge, loss of tissue elasticity and frequent urinary urgency or infections.

It is important to note, however, that after 40, thrush becomes less common, in conjunction with GSM becoming more common at this age.

Diagnosis of GSM can be made usually by a menopause specialist and or a vulval specialist. Find a consultant via the British Menopause Society here or the BSSVD here.

Contact dermatitis

Both contact dermatitis and thrush result in acute vulval (the external female genitalia) swelling, redness, itching and irritation.

Contact dermatitis is an allergic reaction or skin irritation caused by external factors - such as scented soaps, laundry detergents, latex condoms, menstrual products, creams or synthetic underwear.

While thrush originates internally from a yeast imbalance in the vagina, contact dermatitis is usually localised to the outer skin (vulva) and resolves when the offending irritant is identified and removed. Contact dermatitis usually results in more of an itch than a burn.

Confirmation of diagnosis should be sought at a vulval clinic, find your nearest here.

Genital herpes

Thrush and genital herpes cause intense vulval burning, itching, swelling, skin fissures and sharp pain during urination. Early or mild herpes outbreaks are frequently mistaken for a yeast infection.

Genital herpes is caused by the herpes simplex virus (HSV-1 or HSV-2). Unlike thrush, herpes typically presents with tiny, fluid-filled blisters that burst into tender, painful sores or shallow ulcers. Before blisters appear in the early stages of an outbreak, however, it is easier to confuse herpes with thrush.

Initial herpes outbreaks can include flu-like symptoms (such as fever, body aches and swollen lymph nodes in the groin), but not always. While thrush causes itching inside and outside the vagina usually with thick discharge, herpes pain is localised to nerve pathways and skin lesions.

Thrush and herpes can coexist - confirmation of diagnosis can be found at your local GUM clinic (here) and if vulval symptoms are a predominant feature, seeking an opinion from a vulval clinician is recommended; find one here.

Bacterial vaginosis (BV)

Both BV and thrush cause changes in vaginal discharge, however, the consistency, colour and smell are distinct from one another.

BV is caused by a bacterial imbalance rather than a fungal overgrowth. While thrush discharge is thick, white, odourless and accompanied by itching, BV produces a thin, watery, greyish-white discharge with a distinct ‘fishy’ odour. Itching is typically minimal or absent in BV.

BV and thrush can coexist - some evidence suggests 30% of patients with BV also have an active thrush infection (Sobel et al 2013).

Specialist treatment can be found at a GUM clinic and or vulval clinic (if vulval symptoms are also present.)

Cytolytic vaginosis

Cytolytic vaginosis (CV) - also termed lactobacillus overgrowth syndrome, or Döderlein’s cytolysis is a controversial condition as there’s not enough evidence to confirm it exists (Kraut 2023), read our in-depth article on the condition here.

In theory, CV describes an overgrowth in protective Lactobacilli bacteria within the vagina, which lowers vaginal pH to an excessively acidic level and dissolves the cells that line your vaginal walls. This causes vulvovaginal symptoms and creates thrush symptoms where curd-like discharge is released as dead skin cells slough off copiously.

This site suggests particular caution of CV diagnoses as gynaecologists are often not taught about menopause, hormones, pelvic nerves and vulvovaginal skin conditions. This means they overdiagnose conditions caused by microbes like CV rather than understand the full breadth of diseases that can affect women, which requires an interdisciplinary understanding of women’s health.

"After a severe thrush infection left a residual burning at the opening of the vagina, I went to a gynaecologist as no GUM clinician nor GP knew what was - I tested negative for everything. I said I didn't have pain in my vagina, but the consultant said, "Well, I think you do have pain in your vagina." They instructed me to douche bicarbonate of soda up the vagina after a diganosis of CV. They said to douche however many times a day for symptom relief. As I had no symptom relief I douched 15 times a day - often some of the water would go up into my uterus and fall down 2 hours later so it'd look like I'd wet myself sometimes at work.

I reported to the consultant's secretary that the treatment wasn't working and their response was "The only patients the Doctor can't help are those who think they know more than him." I continued trying to be a 'good patient' and was given Augmentin when the pain didn't go. This triggered more drug-resistant thrush and moved my pain up from 2/10 to 5/10. I then went to a vulval clinic for a second opinion. They said cytolytic vaginosis was highly controversial and, in fact, I had vestibulodynia - nerve damage of the vulval vestibule. Within a year of the Augmentin, I was unable to work due to pain." – Philly, Founder of Thrush Support

Furthermore, private vaginal microbiome DNA test kits talk about the condition a lot. But often do not have expert vulval clinicians giving you feedback on your results who can rule out other diseases as drivers of pain rather than your vaginal microbiome.

Confirm a diagnosis at your nearest vulval clinic - see here.

(N.B. many vulval specialists do not believe CV exists - email us if you need the name of a vulval consultant who does think it is a real condition; Thrush Support only knows one.)

Vulvodynia

A condition that includes chronic pain, burning, or stinging around the vulva without an active infection or visible skin lesions.

This is an umbrella diagnosis of multiple different conditions that drive pain in the region. Vulvodynia can be localised often to the vestibule (vestibulodynia) or clitorus (clitorodynia) or it can be spread across the whole vulva.

Vulvodynia can be pain only when provoked or unprovoked or a mix.

Causes of vulvodynia highlighted by vulval experts Dr Andrew and Irwin Goldstein in their book “When Sex Hurts” include:

– Congenital neuroproliferative vestibulodynia (being born with too many nerve endings in the vestibule; belly button pain often co-occurs as it develops from similar tissue in the embryo)

– Acquired neuroproliferative vestibulodynia (growing too many nerve endings in the vestibule after inflammatory trauma, most commonly a severe yeast infection or series of them)

– Hormonally mediated vestibulodynia (pain caused due to a suppression of oestrogen and testosterone often following prolonged systemic contraceptive use)

– Pelvic floor muscle dysfunction (clenching of the muscles from pain can cause a build-up in lactic acid and pain in the vestibule)

– Pudendal neuralgia - often unprovoked pain of a burning nature following an inflammatory trauma e.g. childbirth, hysterectomy, bike riding and in Thrush Support’s founder experience, severe thrush infections

Your subtype of vulvodynia needs to be identified for effective treatment; that’s usually done at a vulval clinic.

Those with unprovoked pain with any additional diagnosis of chronic pain should have their pain managed in a pelvic pain clinic. Contact us for help on finding your nearest centre.

Trichomoniasis

A common sexually transmitted infection (STI) caused by the parasite Trichomonas vaginalis.

When symptoms occur, they may include a frothy, yellow-green or unpleasant-smelling vaginal discharge, vulval itching or soreness, pain when urinating or during sex and occasionally spotting after intercourse. Unlike thrush, the discharge is not typically thick and curd-like.

A GUM clinic should be able to confirm the diagnosis - find your nearest here.

Desquamative inflammatory vaginitis (DIV)

A rare, chronic inflammatory condition seen mostly in perimenopausal women. It presents with long-term burning, pain and a yellow discharge that can be mistaken for a yeast infection, though symptoms are often nonspecific, which often lead to misdiagnosis and incorrect treatment (Martin et al., 2020).

Diagnosis and management is required from an expert consultant - seek a vulvovaginal specialist here.

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Conditions mistaken for thrush

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