From the Guidelines
The recommended treatment for yeast vaginitis is a short course of topical azoles, such as clotrimazole or miconazole, or a single dose of oral fluconazole 150mg, as these options have been shown to be effective in treating uncomplicated cases of vulvovaginal candidiasis (VVC) 1.
Treatment Options
- Topical azoles: clotrimazole (1% cream applied intravaginally for 7 days or 2% cream for 3 days) or miconazole (2% cream for 7 days or 4% cream for 3 days)
- Oral fluconazole: 150mg as a single dose
Considerations
- For severe or recurrent infections, a longer course of treatment may be needed, such as fluconazole 150mg every 72 hours for 3 doses, or extended topical therapy for 7-14 days
- Patients should avoid douching, scented hygiene products, and tight-fitting synthetic underwear during treatment
- Sexual partners generally do not require treatment unless they have symptoms
Evidence
The Centers for Disease Control and Prevention (CDC) recommends the use of topical azoles or oral fluconazole for the treatment of VVC, as outlined in their 2021 treatment guidelines 1. The Infectious Diseases Society of America (IDSA) also recommends the use of topical or oral antifungal agents for the treatment of VVC, with a preference for fluconazole as the oral agent of choice 1.
From the FDA Drug Label
Fluconazole tablets are a prescription medicine used to treat vaginal yeast infections caused by a yeast called Candida. Fluconazole tablet helps stop too much yeast from growing in the vagina so the yeast infection goes away The recommended treatment for yeast vaginitis is fluconazole tablets.
- The treatment is administered orally, which is different from other treatments for vaginal yeast infections.
- Fluconazole helps stop the growth of yeast in the vagina, allowing the infection to clear up. 2
From the Research
Treatment Options for Yeast Vaginitis
- The recommended treatment for yeast vaginitis includes antifungal medications, such as fluconazole, clotrimazole, and itraconazole 3, 4, 5.
- Fluconazole is a commonly used oral medication, which has been shown to be effective in treating yeast vaginitis, with a clinical cure rate of 94% at 14-day evaluation 3.
- Clotrimazole is a topical medication, which is also effective in treating yeast vaginitis, with a clinical cure rate of 97% at 14-day evaluation 3.
- Itraconazole is another oral medication, which has been shown to be effective in treating yeast vaginitis, with a clinical cure rate of 60% 5.
Comparison of Treatment Options
- A study comparing fluconazole and clotrimazole found that both medications were effective in treating yeast vaginitis, with no significant difference in clinical or mycologic cure rates 3.
- Another study comparing fluconazole, itraconazole, and terbinafine found that fluconazole had a higher clinical cure rate (66.6%) compared to itraconazole (60%) and terbinafine (33.3%) 5.
- A study on the treatment of complicated Candida vaginitis found that a 2-dose fluconazole regimen achieved higher clinical cure rates compared to a single dose of fluconazole 4.
Considerations for Treatment
- The treatment of yeast vaginitis should be individualized, taking into consideration the severity of the disease, history of recurrent vaginitis, and patient preference 3, 4.
- Patients with severe or recurrent vaginitis may require longer-duration antifungal therapy to achieve clinical cure and mycologic eradication 4.
- Non-albicans species, such as Candida glabrata and Saccharomyces cerevisiae, may be less responsive to certain antifungal medications, such as fluconazole and terconazole 6.