What is the treatment for vaginal pruritus?

From the Guidelines

Vaginal itchiness can be effectively treated with a single dose of fluconazole or short-course topical formulations of azole antifungals, such as clotrimazole or miconazole, for 1-7 days, as these achieve relief of symptoms and negative cultures in 80-90% of patients with uncomplicated vulvovaginal candidiasis 1.

Treatment Options

• For uncomplicated vulvovaginal candidiasis, which accounts for about 90% of cases, treatment with azoles, such as fluconazole, clotrimazole, or miconazole, is recommended 1.
• The treatment should be administered for 1-7 days, depending on the severity of symptoms and the specific antifungal agent used 1.
• For complicated vulvovaginal candidiasis, which includes severe or recurrent disease, infection due to non-albicans species, and/or infection in an abnormal host, treatment should be administered intravaginally with topical agents for 5-7 days or orally with fluconazole 150 mg every 72 hours for 3 doses 1.

Home Remedies and Prevention

• Simple home remedies, such as wearing loose cotton underwear, avoiding scented products in the genital area, and practicing good hygiene with gentle, unscented soap and water, can help prevent recurrence of vaginal itchiness [@Example@].
• Avoiding douching, which disrupts the vaginal flora, is also recommended [@Example@].
• If itching persists beyond a week, is accompanied by unusual discharge, odor, or pain, consulting a healthcare provider is necessary, as it could indicate a more serious condition requiring prescription treatment [@Example@].

Diagnosis and Confirmation

• A diagnosis of vulvovaginal candidiasis can usually be made clinically when a woman presents with symptoms of pruritus, irritation, vaginal soreness, external dysuria, and dyspareunia, often accompanied by a change in vaginal discharge 1.
• Confirmation of the diagnosis should be made by a wet-mount preparation with use of saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae and a normal pH (4.0–4.5) 1.
• Vaginal cultures for Candida should be obtained for those with negative findings 1.

From the FDA Drug Label

If you have symptoms (such as itching and irritation) on the skin outside the vagina (vulva), apply the cream externally 2 times a day, up to a total of 7 days, as needed. Use the cream twice daily, for up to 7 days as needed. Apply the cream onto the skin outside the vagina (vulva) that itches and is irritated.

The treatment for vaginal itchiness is to apply the miconazole nitrate cream externally to the affected area, 2 times a day, for up to 7 days as needed.

• The cream should be applied to the skin outside the vagina (vulva) that itches and is irritated.
• If symptoms do not get better in 3 days, or if they last more than 7 days, you should stop use and ask your doctor 2.
• You should also stop using the product and consult your doctor if you have abdominal pain, hives, skin rash, or if you have severe vaginal burning, itching, or irritation or swelling 2.

From the Research

Vaginal Itchiness Treatment Options

• Vaginal itchiness can be caused by various factors, including infections such as candidal, bacterial, and trichomonal vaginitis 3.
• Treatment options for vaginal itchiness include:
  • Antifungal medications such as fluconazole, clotrimazole, and miconazole 4, 5, 6.
  • Antibacterial medications such as metronidazole 3, 5, 7.
  • Combination therapy using both systemic and topical treatments 4.
• Topical association of metronidazole and clotrimazole has been shown to be effective against a broad spectrum of pathogens, including bacterial, fungal, and protozoan infections 5.
• Probiotic consumption has been found to have a negative correlation with the rate of recurrence of vulvovaginal candidiasis 6.

Treatment Efficacy

• A study found that treatment with metronidazole and miconazole resulted in a microbiological cure rate of 97.3% for trichomonal, 86.6% for bacterial, and 81% for candidal vaginitis 3.
• Another study found that combined systemic and topical therapy using fluconazole and metronidazole/clotrimazole resulted in a significant reduction in the risk of mycological recurrence at the 12-month mark 4.
• A review of systematic reviews and meta-analyses found that treating individuals with fluconazole, ketoconazole, clotrimazole, and oteseconazole demonstrated a significant reduction in the risk of mycological recurrence at the 12-month mark 6.

Treatment Safety

• The safety of treatment options for vaginal itchiness has been evaluated in several studies, with most finding that the treatments are well-tolerated and effective 3, 4, 5, 6.
• However, more studies are needed to fully assess the safety and efficacy of treatment options, particularly for specific conditions such as pregnancy or immunodeficiency 6.