Vaginal discharge: normal, thrush, or not thrush at all
Almost every woman has treated "thrush" with something from a pharmacy at least once, and in roughly half of those cases it was not thrush. Hence the familiar pattern: better for three days, then back again. Here is how to tell them apart from the symptoms, and what to test so you are not guessing.
What normal discharge looks like
Every woman has discharge, and its absence is not a sign of health. Mucus is produced continuously and changes through the cycle: that is oestrogen at work, not a symptom.
| Point in the cycle | What it looks like | Why |
|---|---|---|
| just after a period | scant, thickish, white | oestrogen is still low |
| towards mid-cycle | more of it, clear, stretchy like egg white | preparation for ovulation: the mucus lets sperm through |
| after ovulation | less, thicker, white or creamy | progesterone is at work |
| before a period | sometimes more and thicker | an ordinary fluctuation |
Normal discharge is white or clear, without a strong smell, and causes no itching or burning. It may dry to a yellowish shade on underwear — that is oxidation in air, not infection.
Discharge naturally increases in pregnancy, on hormonal contraception and with arousal. After menopause the opposite happens: there is noticeably less of it, because oestrogen is low.
The three conditions people confuse
Almost everything troublesome is one of three, and they differ in ways that are quite visible:
| Thrush grzybica pochwy | Bacterial vaginosis waginoza bakteryjna | Trichomoniasis rzęsistkowica | |
|---|---|---|---|
| Discharge | thick, white, lumpy, like cottage cheese | thin, uniform, greyish-white | yellow-green, frothy |
| Smell | usually none | fishy, stronger after sex | strong |
| Itching | severe — the main symptom | usually none | present |
| Burning, redness | yes, often swelling | rarely | yes |
| Sexually transmitted | no | no | yes — the partner is treated too |
| Treatment | antifungals | antibiotics — antifungals do nothing | specific drugs, both partners |
And there is the answer to the main question. Thrush is about itching; vaginosis is about smell. If there is no itch but there is a fishy smell, an antifungal will not help, because there is no fungus there.
Bacterial vaginosis is not an infection caught from outside but a shift in your own flora: fewer lactobacilli, more of everything else. It cannot be "caught", and there is nobody to blame for it.
Why the treatment does not work
Three common reasons the cycle repeats:
- The wrong thing was treated. Antifungals are useless in vaginosis, and an antibiotic in thrush makes matters worse by finishing off what lactobacilli are left;
- The course was not finished. The itch stops on day two or three and the treatment is abandoned. The return a week later follows directly;
- There is a cause nobody looked for. Recurrent thrush — four or more episodes a year — is a reason to check blood glucose and reconsider contraception, not to buy pessaries a fourth time.
What to test so you are not guessing
All three are told apart in a single visit, for less than two unsuccessful courses of pessaries.
- A vaginal swab (in Polish wymaz z pochwy; on the report, biocenoza or czystość pochwy) — under the microscope it shows whether there is fungus, how many lactobacilli there are, and whether clue cells typical of vaginosis are present;
- A culture with sensitivity testing (posiew) — when treatment has already failed. It shows which bacterium is there and what it responds to, so the treatment follows the result rather than a guess;
- pH — a quick pointer at the visit itself: normal acidity in thrush, raised in vaginosis.
Taking the sample is included in the price of the visit; only the laboratory is charged separately — usually 60–130 zł for a culture with sensitivity testing.
Important: do not treat yourself before the swab. A pessary used the previous evening makes the result unreadable and everything has to be repeated. If a course has already started, finish it and come a week after it ends.
When a visit is essential
Some signs make self-treatment inappropriate in principle:
- discharge with blood outside a period;
- any discharge after menopause;
- lower abdominal pain, fever;
- discharge during pregnancy, especially watery or with an odour;
- itching that does not settle after a course of treatment;
- discharge after unprotected sex with a new partner — that calls for a different set of tests;
- four or more episodes of thrush in a year.
Appointments in Warsaw at ul. Głębocka 9, held in Polish, Russian and Ukrainian. No referral or NFZ insurance is needed and a PESEL number is not required. I take the sample at the same visit — there is no need to come back a second time.
Short answers
How do I tell thrush from normal discharge?
Normal discharge is white or clear, has no strong smell and causes no itching. Thrush is above all severe itching plus thick, white, lumpy discharge, often with redness and burning. If there is no itch but there is a fishy smell, it is more likely bacterial vaginosis, and antifungals do not work on that.
Why do antifungal pessaries not help?
Usually because it is not thrush. Bacterial vaginosis produces thin greyish-white discharge with a fishy smell and is treated with antibiotics, not antifungals. The second reason is a course abandoned on day three: the itch stops before the treatment is finished.
Can bacterial vaginosis be caught from a partner?
No. It is not an infection from outside but a shift in your own flora: fewer lactobacilli, more of other bacteria. Partners are therefore not usually treated, and douching "for cleanliness" makes it worse by washing out what keeps the environment acidic.
Which test should I have for discharge?
A vaginal swab — the microscope shows whether there is fungus, how many lactobacilli there are and whether there are signs of vaginosis. If treatment has already failed, a culture with sensitivity testing is added so the treatment follows the result. No pessaries or creams before the sample is taken.
Does my partner need treatment?
For thrush and bacterial vaginosis usually not: neither is sexually transmitted. Partners are treated for trichomoniasis and other sexually transmitted infections, where it is essential — otherwise the infection comes back.
This text describes the general picture and does not replace a consultation. Timings and indications differ from woman to woman and are decided at the appointment, from your history and test results.
