4 Differential diagnoses
Conditions with symptoms that may be confused with vulvovaginal candidiasis include:
€¢ Bacterial vaginosis: vaginitis (vaginal inflammation) caused by a combination of bacterial species. Discharge may be confused with thrush, but it is white and watery with a strong 'fishy' odour. Itching is less prominent than in candidiasis.
€¢ Trichomoniasis: an STD caused by a protozoan parasite, Trichomonas vaginalis. As in thrush, there is vulval itching, but discharge is profuse, frothy, yellowgreen in colour and with an unpleasant odour.
€¢ Cystitis: with thrush, discomfort when urinating may be confused with dysuria associated with cystitis. However, in thrush the discomfort and burning are in the external vaginal area.
€¢ Atrophic vaginitis: in postmenopausal women lack of oestrogen reduces vaginal resistance to infection and injury, which can produce similar burning and itching symptoms to thrush.
€¢ Adverse drug reactions: drugs that can predispose to thrush include broad-spectrum antibiotics, corticosteroids and drugs that can affect oestrogen levels, including oral contraceptives, hormone replacement therapy, tamoxifen and raloxifene.