Thrush, BV & Vaginal Infections in Ireland — Patient Guide

Getting the diagnosis right matters

Vaginal infections are common — at least 1 in 3 women in Ireland will experience one in their lifetime. The three most common patterns — vaginal thrush (candidiasis), bacterial vaginosis (BV), and trichomoniasis — have different causes and need different treatments. Treating BV with antifungal cream, or thrush with antibiotics, will not help and may worsen symptoms. So identifying which infection you have is important.

Thrush (vulvovaginal candidiasis)

Fungal infection caused by Candida species. Not classified as an STI, though sexual activity can sometimes trigger.

• Symptoms: intense itch, thick "cottage cheese" white discharge (typically not malodorous), redness, soreness, pain on intercourse or urination
• Triggers: recent antibiotics, pregnancy, diabetes (especially poorly controlled), high-oestrogen contraception, tight synthetic clothing, vaginal douching
• Treatment: topical clotrimazole cream + intravaginal pessary OR single-dose oral fluconazole (150 mg). Both equally effective for most cases
• Recurrent thrush (4+ episodes/year) — induction + maintenance regimen; also check for underlying triggers like diabetes

Bacterial vaginosis (BV)

Disruption of the normal vaginal bacterial balance — overgrowth of anaerobic bacteria. Not an STI but more common with new or multiple partners.

• Symptoms: thin grey or off-white discharge, characteristic "fishy" smell (often more noticeable after intercourse), usually no itch or significant soreness
• Triggers: new sexual partner, douching, IUD (some), bath products
• Treatment: oral metronidazole 5–7 days OR intravaginal metronidazole gel OR clindamycin cream
• Recurrence: common — addressing triggers reduces frequency
• Importance: BV in pregnancy is associated with preterm labour risk and warrants treatment

Trichomoniasis

A sexually transmitted infection caused by the parasite Trichomonas vaginalis.

• Symptoms: frothy yellow-green discharge, malodorous, sometimes intense itch and soreness, pain on intercourse
• Diagnosis: swab testing — important to identify because partner treatment is required
• Treatment: oral metronidazole — patient AND all current sexual partners
• STI screen recommended — co-infection with chlamydia/gonorrhoea is common

When in-person review is appropriate

• First-ever vaginal symptoms — to confirm diagnosis and exclude STIs
• Pregnancy
• Recurrent or atypical symptoms
• Severe presentation with significant swelling
• Uncertain diagnosis (overlapping symptoms)
• Girls under 16
• Symptoms with bleeding, pelvic pain, or systemic symptoms

Online Doctor consultation

For typical recurrent presentations where the pattern is clear, an Online Doctor can prescribe appropriate treatment. For first-ever symptoms or uncertain diagnosis, in-person review with swab confirms the cause and rules out other infections. STI screening is available via HSE sexual-health clinics or postal services.