6.             Referral criteria:

·       If vaginal candidiasis has not been previously diagnosed by a doctor, as the woman may be have one of the other conditions described above. An initial medical diagnosis of candidiasis is necessary so that sufferers can recognise the condition subsequently.

·       Patients with recurrent attacks: more than two within the previous 6 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 due to the lack of vaginal oestrogen, which favours growth of C. albicans, but lack of oestrogen increases susceptibility to other vaginal infections. 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 treatment with OTC medication.