From the Guidelines
The treatment for vulvar candidiasis typically involves antifungal medications applied directly to the affected area, with first-line treatment being topical azole creams such as clotrimazole 1% cream applied intravaginally daily for 7–14 days, as recommended by the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
- 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
- Prescription intravaginal agents:
- Butoconazole 2% cream: 5 g intravaginally in a single application
- Terconazole 0.4% cream: 5 g intravaginally daily for 7 days
- Oral agent:
- Fluconazole 150 mg: single dose
Additional Recommendations
During treatment, patients should keep the vulvar area clean and dry, wear loose cotton underwear, avoid tight clothing, and refrain from using irritating products like scented soaps or douches 1. Sexual partners generally don't need treatment unless they have symptoms. For severe cases or recurrent infections, oral fluconazole 150 mg as a single dose may be prescribed 1.
Recurring Vulvovaginal Candidiasis
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
Terconazole vaginal cream 0.4% is indicated for the local treatment of vulvovaginal candidiasis (moniliasis).
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 vulvar candidiasis is the application of an antifungal cream, such as terconazole or miconazole, to the affected area. The cream should be applied twice daily for up to 7 days as needed. It is essential to confirm the diagnosis through KOH smears and/or cultures before starting treatment 2.
- Key points:
From the Research
Treatment Options for Vulvar Candidiasis
- The treatment for vulvar candidiasis, also known as vulvovaginal candidiasis (VVC), typically involves antifungal medications 4, 5, 6, 7.
- Local azoles, such as clotrimazole, miconazole, and terconazole, are commonly used to treat uncomplicated VVC 5, 6, 7.
- Oral fluconazole is also effective for treating uncomplicated VVC, and can be used as a single dose or multiple doses for complicated cases 4, 7.
- For recurrent VVC, maintenance therapy with topical antifungals, such as clotrimazole or miconazole, may be necessary 4.
Topical Treatment Regimens
- Topical clotrimazole has been shown to be effective in treating VVC, with high cure rates and low risk of resistance 5.
- A single dose of clotrimazole 500 mg vaginal tablets can be as effective as oral azoles, and prolonged treatment regimens can be effective in severe and recurrent cases 5.
- Twice a week dosing of topical antifungals may be used for maintenance therapy in women with recurrent VVC 4.
Advanced Treatment Options
- Advanced solid formulations, such as intravaginal rings, vaginal films, sponges, and nanofibers, are being developed to improve drug delivery and reduce systemic adverse effects 8.
- These formulations can provide sustained drug release and high mucoadhesion, and may offer advantages over conventional dosage forms such as creams and ointments 8.
Special Considerations
- Treatment of VVC during pregnancy should be approached with caution, and fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided 4.
- Identification of the species of Candida causing the infection can influence treatment decisions, and prior response to a specific agent should be taken into account 4.