Oral and Esophageal Thrush: Symptoms, Causes, and Treatment Guide

Thrush (candidiasis) is a fungal infection caused by Candida species, most commonly C. albicans. It affects mucous membranes—oral, esophageal, genital—especially when immunity or local ecology is disrupted.

Oral Thrush Symptoms

• White/yellow creamy plaques on tongue, buccal mucosa, palate; bleed when scraped.
• Soreness, burning, dysphagia.
• Angular cheilitis (cracks at mouth corners).
• Loss or alteration of taste.

Esophageal Thrush (Candidal Esophagitis)

• Odynophagia (painful swallowing), dysphagia (food sticking).
• Retrosternal burning.
• Often indicates immunosuppression (HIV, steroids, chemotherapy).

Genital Thrush

• Vulvovaginal: thick white discharge, intense itch, erythema, dyspareunia.
• Balanitis (men): erythema, itching, white plaques on glans/foreskin.

Common Predisposing Factors

• Antibiotics (disrupt normal flora).
• Corticosteroids (inhaled or systemic).
• Diabetes mellitus (poor control).
• Immunosuppression (HIV, transplant, chemotherapy).
• Dentures (poor hygiene, overnight wear).
• Xerostomia (dry mouth).

Treatment

• Oral: Topical nystatin suspension/clotrimazole troches 7–14 days; fluconazole 100–200 mg daily for refractory cases.
• Esophageal: Systemic fluconazole 200–400 mg daily 14–21 days; echinocandins if azole‑resistant.
• Genital: Topical azoles (clotrimazole, miconazole) or single‑dose oral fluconazole 150 mg.

When to Seek Care

• Symptoms persist >1 week on OTC therapy.
• Esophageal symptoms (odynophagia).
• Recurrent episodes (≥4/year).
• Underlying immunosuppression or uncontrolled diabetes.