What is the treatment for vaginal candidiasis (Vaginal Yeast Infection)?

From the Guidelines

Vaginal candidiasis should be treated with a single 150-mg oral dose of fluconazole or topical azoles like clotrimazole or miconazole for uncomplicated cases, as recommended by the most recent guidelines 1.

Treatment Options

• Topical azoles: clotrimazole (1% cream applied intravaginally for 7 days or 2% cream for 3 days), miconazole (2% cream for 7 days or 4% cream for 3 days)
• Oral agent: fluconazole 150 mg single dose

Considerations

• For severe or recurrent infections, a longer course of treatment may be necessary, such as fluconazole 150 mg taken orally every 72 hours for three doses, followed by weekly doses for 6 months for maintenance therapy in recurrent cases 1
• Over-the-counter treatments are available, but persistent or recurrent infections should prompt medical consultation
• During treatment, avoiding irritants like scented products, wearing breathable cotton underwear, and maintaining good hygiene can help recovery

Diagnosis

• Microscopy and clinical diagnosis have poor sensitivity, while yeast cultures can lead to a delay in diagnosis and treatment 1
• Molecular testing for VVC has high clinical accuracy and may be used for diagnosis

Recommendations

• The Infectious Diseases Society of America recommends topical antifungal agents or a single 150-mg oral dose of fluconazole for the treatment of uncomplicated Candida vulvovaginitis 1
• For recurring vulvovaginal candidiasis, 10–14 days of induction therapy with a topical agent or oral fluconazole, followed by fluconazole, 150 mg weekly for 6 months, is recommended 1

From the FDA Drug Label

Fluconazole tablets are indicated for the treatment of: Vaginal candidiasis (vaginal yeast infections due to Candida). Uses treats vaginal yeast infections relieves external itching and irritation due to a vaginal yeast infection

Treatment options for vaginal candidiasis include:

• Fluconazole (PO), as indicated in the drug label 2
• Clotrimazole (PV), which treats vaginal yeast infections and relieves external itching and irritation 3

From the Research

Treatment Options for Vaginal Candidiasis

• The treatment of vaginal candidiasis can involve various antifungal medications, including fluconazole, clotrimazole, and itraconazole 4, 5, 6, 7, 8.
• A study published in 1989 compared the efficacy of single-dose oral fluconazole with 3-day intravaginal clotrimazole in the treatment of vaginal candidiasis, finding that fluconazole was more effective in the long term and relieved symptoms more rapidly 5.
• Another study published in 1995 compared the efficacy of clotrimazole, fluconazole, and itraconazole in vaginal candidiasis, finding that itraconazole and clotrimazole were more effective than fluconazole in treating acute vaginal candidiasis 6.
• A 2016 study compared the efficacy and safety of clotrimazole vaginal tablet with oral fluconazole in treating severe vulvovaginal candidiasis, finding that the two treatments were equally effective 7.
• Local treatment is often the first line of choice in cases of acute vaginal yeast infection, with a success rate of 84-90% 8.
• Systemic therapy with oral antifungals such as fluconazole may be used for chronic, recurrent, or resistant forms of vaginal candidosis, with treatment lasting at least 6 months 8.

Combination Therapy

• A 2019 study proposed a combined treatment scheme using both systemic antimicrobial drug therapy with oral fluconazole and topical drug therapy using metronidazole and clotrimazole, with adjuvant oral probiotic therapy 4.
• This scheme aims to address the recurrent infection aggressively from the outset, attempting to treat acute symptoms and prevent new events by countering potential risk factors of recurrence 4.

Efficacy and Safety

• The efficacy and safety of different treatment options for vaginal candidiasis have been compared in various studies, with fluconazole, clotrimazole, and itraconazole showing varying degrees of effectiveness and safety 5, 6, 7.
• Adverse events associated with these treatments are generally few and minor, with local adverse events being more common with topical treatments 5, 7.