Conjunctivitis, cold sores and thrush are three of the most common problems people ask a pharmacist about. They are uncomfortable, and sometimes embarrassing, but they are usually not serious and can often be managed with the right advice and treatment from your local pharmacy. This guide explains the causes, the treatments available, and the signs that mean you should see a GP or get urgent help.

If you would like to talk it through, our pharmacists at Oldfield Pharmacy in Altrincham can assess your symptoms and recommend suitable treatment. Note that these three conditions are not among the seven NHS Pharmacy First conditions, but a pharmacist can still help you choose the right treatment and tell you if you need a GP.

The Three Conditions at a Glance

• Conjunctivitis: a red, sore or sticky eye. It is often viral or bacterial, and eye drops can ease it. It usually clears within one to two weeks.
• Cold sores: blisters around the lips or mouth caused by a virus. They usually heal in 7 to 10 days, and an antiviral cream works best if you start it at the first tingle.
• Thrush: a yeast infection that can affect the vagina, penis, mouth and skin folds. It is treated with antifungal medicines.

Conjunctivitis

What is conjunctivitis?

Conjunctivitis, often called pink eye, is inflammation of the conjunctiva, the thin clear layer that covers the white of the eye and the inside of the eyelids. Typical symptoms include red or pink eyes, a gritty or burning feeling, watering, and a sticky discharge that can crust the eyelashes overnight. It often begins in one eye and spreads to the other.

Conjunctivitis causes

There are several causes, and the cause affects the treatment:

• Viral conjunctivitis: the most common type, often linked to a cold or sore throat. It is contagious and antibiotics do not work on it.
• Bacterial conjunctivitis: often causes a thicker, sticky yellow or green discharge. It is also contagious.
• Allergic conjunctivitis: a reaction to things like pollen, house dust mites, animal fur, eye drops, eye make-up or contact lenses. It usually affects both eyes, causes itching, and is not contagious. If your eyes are itchy and your nose is streaming too, read our guide to hay fever treatment in Manchester.
• Irritant conjunctivitis: caused by things such as chlorine in swimming pools, smoke, or chemicals splashed in the eye.

Conjunctivitis and the NHS: what to do at home

NHS advice is that most people do not need to see a GP for conjunctivitis, and a pharmacist is a good first step. Viral and bacterial conjunctivitis usually get better by themselves within about two weeks. In the meantime you can ease symptoms by:

• Gently cleaning your eyelids and lashes with cotton wool soaked in cooled boiled water, using a fresh piece for each eye
• Holding a cool, clean damp cloth over closed eyes to soothe discomfort
• Not wearing contact lenses until your eyes have fully recovered
• Washing your hands often, and not sharing towels, pillows or make-up
• Avoiding close contact with others if the cause is infectious, although you can usually still go to work or school

Read the NHS information on conjunctivitis for more detail.

Eye drops for conjunctivitis

The right eye drops depend on the cause, so it is worth asking a pharmacist before you buy anything:

• Lubricating drops or gels: used for viral conjunctivitis and general irritation. They soothe dryness and discomfort.
• Antibiotic drops or ointment: a pharmacist may recommend an antibiotic such as chloramphenicol for bacterial conjunctivitis. It is generally used in people aged two years and over, and your pharmacist will check whether it is suitable for you. Children under two years old should be seen by a GP.
• Antihistamine or allergy eye drops: help with itching and watering in allergic conjunctivitis.

Always follow the instructions on the pack and from your pharmacist, and do not share drops with anyone else.

When to get urgent help

See a GP, optician or urgent care straight away if you have:

• Pain inside the eye
• Sensitivity to light
• Blurred vision or any change in your sight
• Severe redness in one eye
• A newborn baby with a sticky eye, or a baby who seems unwell
• A weakened immune system
• Blisters or a rash around the eye
• Symptoms that are not better after two weeks, or are getting worse

If you wear contact lenses and have a red, painful eye, take them out and get advice promptly.

Cold Sores

What is a cold sore?

A cold sore is a small, fluid-filled blister that appears on or around the lips or mouth. Cold sores are caused by the herpes simplex virus, which most people pick up in childhood. After the first infection the virus stays in the body and can flare up from time to time. About one in five people in the UK get cold sores regularly.

Most people feel a tingling, itching or burning sensation a day or so before the blisters appear. The blisters then burst, crust over and heal, usually within 7 to 10 days. Common triggers include illness, sunshine, being run down or stressed, and periods.

Cold sore treatment

There is no cure for the virus, but you can ease symptoms and sometimes shorten an outbreak:

• Antiviral cream: a cream containing aciclovir can help if you start it at the first sign of tingling. Wash your hands before and after applying it, and dab it on rather than rubbing it in. It is normally used five times a day for about five days, and for up to five more days if the sore has not healed.
• Cold sore patches: hydrocolloid patches cover the blister, help it heal, make it less noticeable and protect it from touching.
• Pain relief: simple painkillers can ease soreness. Ask your pharmacist what is suitable for you.
• Self-care: eat cool, soft foods, avoid acidic or salty foods if they sting, and use an SPF 15 or higher lip balm outside, because sun can trigger a cold sore.

Antiviral tablets are only available on prescription. They may be considered for people with very large or painful sores, frequent outbreaks, or a weakened immune system. If you think you need these, speak to your GP.

How to stop cold sores spreading

Cold sores are contagious from the first tingle until they have completely healed, and they are most infectious when the blisters burst. To protect others:

• Avoid kissing and close contact, and do not share cups, cutlery, towels, lip balm or razors.
• Try not to touch the sore, and wash your hands if you do.
• Do not have oral sex until the sore has fully healed, because the virus can cause genital herpes.
• Keep away from newborn babies. Kissing a baby when you have a cold sore can lead to neonatal herpes, which is very serious.

When to see a GP about a cold sore

See a GP if the cold sore has not started to heal within 10 days, is very large or painful, or you are worried it could be something else, such as impetigo. Also seek advice if you are pregnant, have a weakened immune system (for example, because of chemotherapy or diabetes), or you or your child have painful, swollen gums and mouth sores. Get medical advice quickly if a cold sore is near your eye or you have eye symptoms.

Thrush

Thrush is an infection caused by a yeast called Candida. Candida is normally present on our skin and in our mouths and genitals in small amounts without causing problems. Thrush develops when it grows out of control. It is common, it is not usually serious, and it affects both women and men.

Vaginal thrush

Vaginal thrush often causes:

• Itching, soreness and redness around the vagina and vulva
• A thick, white discharge that does not usually smell
• Stinging when passing urine or during sex

What causes vaginal thrush? Things that can disturb the natural balance include antibiotics, hormonal changes (such as pregnancy or the time around your period), diabetes and a weakened immune system. Thrush is not classed as a sexually transmitted infection. Its symptoms can overlap with other problems, including cystitis, so if you are not sure what you have, read about our UTI treatment service or speak to a pharmacist.

Treatment for thrush

There are several effective options, and a pharmacist can help you choose:

• Antifungal pessary: a tablet placed in the vagina, such as clotrimazole.
• Antifungal cream: a cream such as clotrimazole eases itching and soreness around the outside. It can be used alongside other treatments.
• Oral antifungal capsule: a single-dose capsule such as fluconazole is an option for adults, but it is not suitable in pregnancy or when breastfeeding, and it can interact with some medicines, including warfarin, certain statins and some antidepressants. Always tell the pharmacist what you take.

Do not use antifungal medicines more than twice in six months without speaking to a pharmacist or doctor. Most uncomplicated cases clear up within about a week of treatment.

See a GP if it is your first time having symptoms, you are under 16 or over 60, you are pregnant or breastfeeding, the treatment has not worked, or thrush keeps coming back (more than four times in 12 months). A GP can check for causes such as diabetes and recommend a longer course.

Thrush in men

Men can get thrush too, usually on the head of the penis and under the foreskin. Signs include redness, soreness, itching and a white discharge. Antifungal cream can help, and men should see a GP if it is the first time they have had symptoms.

Oral thrush and oral yeast infection causes

Oral thrush is a yeast infection in the mouth. It can cause white or creamy patches on the tongue and inside the cheeks, a sore or cracked mouth, redness, and a change in taste.

The causes of an oral yeast infection include anything that lets Candida overgrow, such as:

• Wearing dentures, especially if they are not cleaned well or are worn overnight
• Using a steroid inhaler (rinse your mouth after each use)
• Taking antibiotics
• Diabetes
• Dry mouth and smoking
• A weakened immune system, including during cancer treatment
• In babies, because their immune systems are still developing

A pharmacist can recommend an antifungal oral gel for mild cases. Some antifungal medicines can interact with warfarin and other medicines, so always mention what you take. Stronger antifungal tablets for oral thrush need a prescription. Babies under four months old with white patches in the mouth should be checked by a GP or health visitor, and adults who keep getting oral thrush should see their GP in case there is an underlying cause.

How a Pharmacist Can Help

A pharmacist can look at your symptoms, tell you whether it sounds like conjunctivitis, a cold sore or thrush, recommend suitable treatment, and let you know when you need to see a GP or optician. You do not have to feel embarrassed. Pharmacists talk about these things every day, and you can ask for a private space if you would prefer to speak discreetly.

At Oldfield Pharmacy, we offer advice and treatment recommendations for common minor conditions in Manchester and Altrincham. If you need a prescription-only treatment, our superintendent pharmacist is a qualified Independent Prescriber, and we can discuss your options at a private prescribing consultation where it is clinically appropriate.

As your local pharmacy in Manchester, we are also here for repeat prescriptions, health checks and everyday health advice.

Need advice on conjunctivitis, a cold sore or thrush? Book a consultation or call us on 0161 942 9701.

This article is for general information and is not a substitute for personal medical advice. If your symptoms are severe or you are unsure what is wrong, contact your GP, NHS 111 or an optician. See the NHS pages on conjunctivitis, cold sores and thrush for more information.