From the Guidelines
Vulvovaginal fungal infections can be effectively treated with a single 150mg oral dose of fluconazole, which provides systemic coverage, as recommended by the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
The following treatment options are available for vulvovaginal candidiasis:
- Over-the-counter intravaginal agents:
- Clotrimazole 1% cream: 5 g intravaginally daily for 7–14 days
- Clotrimazole 2% cream: 5 g intravaginally daily for 3 days
- Miconazole 2% cream: 5 g intravaginally daily for 7 days
- Miconazole 4% cream: 5 g intravaginally daily for 3 days
- Miconazole 100 mg vaginal suppository: One suppository daily for 7 days
- Miconazole 200 mg vaginal suppository: One suppository for 3 days
- Miconazole 1200 mg vaginal suppository: One suppository for 1 day
- Tioconazole 6.5% ointment: 5 g intravaginally in a single application
- Prescription intravaginal agents:
- Butoconazole 2% cream (single dose bioadhesive product): 5 g intravaginally in a single application
- Terconazole 0.4% cream: 5 g intravaginally daily for 7 days
- Terconazole 0.8% cream: 5 g intravaginally daily for 3 days
- Terconazole 80 mg vaginal suppository: One suppository daily for 3 days
- Oral agent:
- Fluconazole 150 mg: Single dose
Diagnosis and Treatment
Diagnosis of vulvovaginal candidiasis can be made through microscopy, clinical suspicion, or culture, with culture being the gold standard 1. However, molecular testing, such as polymerase chain reaction (PCR), has been shown to have high clinical accuracy and may be a useful diagnostic tool 1.
Patient Advice
During treatment, patients should avoid douching, wear cotton underwear, and avoid tight-fitting clothing to reduce moisture and irritation. Sexual partners generally do not require treatment unless they are symptomatic. Pregnant women should use only topical azoles, as fluconazole is contraindicated in pregnancy.
Evidence Quality
The recommended treatment options are based on high-quality evidence from the 2021 Centers for Disease Control and Prevention guidelines 1 and the 2016 update by the Infectious Diseases Society of America 1.
From the FDA Drug Label
Terconazole vaginal cream 0.4% is indicated for the local treatment of vulvovaginal candidiasis (moniliasis). As terconazole vaginal cream 0.4% is effective only for vulvovaginitis caused by the genus Candida, the diagnosis should be confirmed by KOH smears and/or cultures. Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. In both, the results of the fluconazole regimen were comparable to the control regimen (clotrimazole or miconazole intravaginally for 7 days) both clinically and statistically at the one month post-treatment evaluation
The treatment for vulvovaginitis fungal is Terconazole or Fluconazole.
- Terconazole is indicated for the local treatment of vulvovaginal candidiasis (moniliasis) 2.
- Fluconazole can be used to treat vaginal candidiasis, with a therapeutic cure rate of 55% 3. Key points:
- The diagnosis of vulvovaginal candidiasis should be confirmed by KOH smears and/or cultures.
- Terconazole and Fluconazole are effective for vulvovaginitis caused by the genus Candida.
From the Research
Treatment Options for Vulvovaginitis Fungal
- The treatment for vulvovaginitis fungal, also known as recurrent vulvovaginal candidiasis (RVVC), can be managed through various methods, including topical and oral medications 4, 5, 6, 7, 8.
- Topical treatments such as clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested recommendations for recurrent vulvovaginitis caused by both Candida albicans and nonalbicans species 4.
- Oral fluconazole is also a recommended treatment, but it should be avoided during pregnancy 4, 6, 7, 8.
- A combined systemic (fluconazole) and topical (metronidazole + clotrimazole) therapy has been proposed as a new approach to the treatment and prophylaxis of recurrent candidiasis 6.
- The efficacy and safety of clotrimazole vaginal tablet vs. oral fluconazole in treating severe vulvovaginal candidiasis have been compared, with results showing that two doses of clotrimazole vaginal tablet 500 mg were as effective as two doses of oral fluconazole 150 mg 7.
- Oral fluconazole 150 mg single dose has been compared to intra-vaginal clotrimazole treatment of acute vulvovaginal candidiasis, with results showing that oral fluconazole single dose seems to be a valid and promising therapy to cure acute signs and symptoms of VVC 8.
Recommended Treatment Regimens
- An initial full course of treatment followed by topical maintenance beginning at one to three times weekly, based on chosen agent, is recommended for women with RVVC 4.
- Twice a week dosing was the regimen most often utilized, but in some women, episodic treatment may be used, and maintenance should remain an option for this population 4.
- A treatment scheme using both systemic antimicrobial drug therapy with oral fluconazole 200 mg and topical drug therapy using the association metronidazole 500 mg and clotrimazole 100 mg (vaginal ovules) with adjuvant oral probiotic therapy has been proposed 6.