6 Red Flags: symptoms and circumstances for referral

€¢ If vaginal candidiasis has not been previously diagnosed by a doctor. There are other vaginal infections, some serious and all requiring treatment with prescription-only medication.
€¢ Patients with recurrent attacks: more than two within the previous six months may indicate an underlying cause such as diabetes.
€¢ Patients under 16 or over 60 years of age: thrush is rare in these age groups. OTC treatments are not licensed for use in these groups.
€¢ Pregnant or breastfeeding women: OTC treatments are not licensed for use in these groups. €¢ Abnormal or irregular vaginal bleeding.
€¢ Any blood staining of vaginal discharge.
€¢ Vulval or vaginal sores, ulcers or blisters.
€¢ Lower abdominal pain or dysuria, which may indicate a urinary tract infection.
€¢ Patients with a previous history of sexually transmitted disease or exposure to a partner with such a history, as other infections may be present.
€¢ No improvement after OTC treatment.
€¢ All the above are criteria for referral to a doctor and form part of the licensing conditions for nonprescription sale of azole anticandidal treatments.