From the Guidelines
The diagnosis of vulvovaginal candidiasis (VVC) is typically made based on symptoms and confirmed by a wet mount preparation or culture, and treatment options include over-the-counter antifungal medications such as miconazole or clotrimazole, or a single oral dose of fluconazole 150mg, as recommended by the 2021 Centers for Disease Control and Prevention guidelines 1. The symptoms of VVC include vaginal itching, burning, abnormal discharge, and discomfort during urination or intercourse. Treatment options for VVC are outlined in the guidelines, including:
- Over-the-counter intravaginal agents such as clotrimazole 1% cream, 5 g intravaginally daily for 7–14 days, or miconazole 2% cream, 5 g intravaginally daily for 7 days
- Prescription intravaginal agents such as butoconazole 2% cream, 5 g intravaginally in a single application
- Oral agent fluconazole 150 mg, single dose It is essential to note that the single oral dose of fluconazole 150mg is a recommended treatment option, as it has been shown to be effective in treating VVC, with a high clinical accuracy and sensitivity 1. To prevent recurrence, it is recommended to wear cotton underwear, avoid tight clothing, minimize sugar intake, and consider taking probiotics during future antibiotic courses. If symptoms persist after treatment or recur frequently, it is crucial to consult a healthcare provider, as this may indicate a different condition or resistant infection requiring alternative treatment. The use of antibiotics like amoxicillin can lead to the development of VVC, as they can disrupt the normal vaginal flora, allowing yeast (Candida) populations to overgrow 1. In addition to treatment, it is essential to practice good hygiene, avoid sexual intercourse during treatment, and use condoms to prevent irritation and reinfection, as recommended by the guidelines 1. Overall, the diagnosis and treatment of VVC should be based on the most recent and highest quality evidence, prioritizing morbidity, mortality, and quality of life as the outcome, as recommended by the 2021 Centers for Disease Control and Prevention guidelines 1.
From the FDA Drug Label
A vaginal yeast infection is a common condition caused by an overgrowth of yeast (Candida) that may normally live in the vagina. You can get a vaginal yeast infection at any age. It is most common during the childbearing years Women who are pregnant or diabetic, taking antibiotics, birth control pills or steroids, or who have a weakened immune system are more likely to get repeated yeast infections that may not clear up easily with proper treatment. Some medical conditions can weaken the body's normal ability to fight infection One of the most serious of these conditions is infection with the human immunodeficiency virus (HIV - the virus that causes AIDS). The HIV virus causes the body to be more likely to get infections, including vaginal yeast infections that may not clear up easily with proper treatment If you may have been exposed to HIV and get repeated vaginal yeast infections, you should see your doctor right away. When you have a vaginal yeast infection, you may have one or more of the following symptoms: • vaginal itching • vaginal discharge that may be thick, white, and lumpy like cottage cheese • vaginal soreness, irritation, or burning • rash or redness on the skin outside the vagina (vulva) • burning on urination • painful vaginal intercourse (sex)
The diagnosis of a vaginal yeast infection is based on the presence of symptoms such as vaginal itching, discharge, and irritation. The treatment for a vaginal yeast infection typically involves the use of an antifungal medication, such as miconazole or fluconazole. In this case, since the patient has recently completed a course of amoxicillin, an antibiotic known to disrupt normal vaginal flora, the diagnosis of a vaginal yeast infection is likely. The patient should use an antifungal medication, such as miconazole, as directed, and follow the instructions for use to get the best results. It is also important for the patient to practice good hygiene, such as wearing cotton underwear and loose-fitting clothes, and avoiding the use of scented soaps or douches, to help prevent the growth of yeast. 2 2
From the Research
Diagnosis of Vaginal Yeast Infection
- The diagnosis of vulvovaginal candidiasis is supported by the symptoms of vaginal yeast infection and the recent completion of amoxicillin, an antibiotic known to disrupt normal vaginal flora, leading to an overgrowth of Candida 3, 4.
- Clinical diagnosis should include confirmatory laboratory tests, such as microscopy and fungal culture, especially in women with a history of recurrent vulvovaginal candidiasis 4.
Treatment of Vaginal Yeast Infection
- The treatment of acute vulvovaginal candidiasis can be done with oral fluconazole 150 mg single dose or intra-vaginal clotrimazole 200mg per day for six days 5, 6.
- A combined scheme using both systemic antimicrobial drug therapy with oral fluconazole and topical drug therapy using the association metronidazole and clotrimazole, with adjuvant oral probiotic therapy, has been proposed for the treatment of recurrent vulvovaginal candidiasis 3.
- Clotrimazole vaginal tablet 500 mg has been shown to be as effective as oral fluconazole 150 mg in treating severe vulvovaginal candidiasis 7.
- The choice of treatment should be based on the severity of the infection, the patient's medical history, and the presence of any underlying conditions 4, 6.
Recurrent Vulvovaginal Candidiasis
- Recurrent vulvovaginal candidiasis can significantly impact quality of life, causing both physical and psychological symptoms, and poses a substantial financial burden for women and the health care system 4.
- Long-term maintenance therapy may be required for women with recurrent vulvovaginal candidiasis, with US-based guidelines recommending ≤6 months of maintenance fluconazole treatment 4.
- However, infection recurs in up to 50% of women treated, and there are currently no US Food and Drug Administration-approved treatments for recurrent vulvovaginal candidiasis 4.