From the Guidelines
To treat recurrent vulvovaginal candidiasis (VVC) in females, induction therapy with a topical agent or oral fluconazole for 10–14 days, followed by fluconazole 150 mg weekly for 6 months, is recommended. This approach is based on the strongest and most recent evidence, including a study published in 2022 1, which highlights the efficacy of fluconazole in improving quality of life in women with recurrent VVC.
Key Considerations
- The treatment should start with induction therapy to control the symptoms, followed by a maintenance regimen to prevent recurrence.
- Fluconazole is the preferred choice for maintenance therapy due to its convenience and high efficacy rate, with over 90% of patients achieving control of symptoms 1.
- Topical treatments, such as clotrimazole or miconazole, can be used as an alternative for induction therapy or for women who cannot tolerate oral fluconazole.
- Lifestyle modifications, including wearing loose cotton underwear, avoiding douching and scented hygiene products, and practicing good hygiene, are essential in preventing recurrence.
Additional Treatment Options
- For women with resistant infections, boric acid suppositories (600mg inserted vaginally at bedtime for 14 days) may be beneficial 1.
- A novel oral antifungal agent, oteseconazole, has shown promising results in reducing recurrence rates in women with RVVC, with a remarkably lower rate of recurrence compared to placebo (4% vs 52%) 1.
- A vaccine targeting a hyphal virulence factor of Candida albicans has also been evaluated and shown to be safe, immunogenic, and capable of reducing the frequency of symptomatic VVC for up to 12 months in a subset of women under 40 years of age 1.
Importance of Consultation
Recurrent infections may indicate underlying issues such as diabetes, immunosuppression, or antibiotic use, so it is essential to consult a healthcare provider if infections persist despite treatment. Yeast infections recur because Candida naturally lives in the vagina, and disruptions to the vaginal environment can allow overgrowth of these fungi, causing symptoms like itching, burning, and thick discharge.
From the FDA Drug Label
Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. The remaining one-fourth of enrolled patients had recurrent vaginitis (≥4 episodes/12 months) and achieved 57% clinical cure, 47% mycologic eradication, and 40% therapeutic cure
The treatment for recurrent vulvovaginal candidiasis (VVC) in females is fluconazole 150 mg PO.
- Clinical cure rate is 57%
- Mycologic eradication rate is 47%
- Therapeutic cure rate is 40% 2
From the Research
Treatment Options for Recurrent Vulvovaginal Candidiasis (VVC)
The treatment for recurrent vulvovaginal candidiasis (VVC) in females involves various approaches, including:
- Maintenance fluconazole therapy: Weekly treatment with fluconazole has been shown to be effective in preventing symptomatic VVC 3.
- Topical treatments: Clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested recommendations for recurrent VVC caused by both Candida albicans and non-albicans species 4.
- Combined systemic and topical therapy: A combined scheme using oral fluconazole and topical metronidazole and clotrimazole has been proposed as a new therapeutic approach for RVVC 5.
- Individualized decreasing-dose maintenance fluconazole regimen: This regimen has been demonstrated to be effective and safe in preventing clinical relapses in women with recurrent VVC 6.
- Vaginal nystatin: Vaginal nystatin suppositories have been shown to be effective in treating RVVC, including cases caused by C. glabrata or fluconazole-resistant Candida 7.
Key Considerations
When treating recurrent VVC, it is essential to consider the following:
- The type of Candida species involved: Different species may respond differently to various treatments 4, 7.
- Prior response to treatment: Treatment may be modified based on prior response to a specific agent, especially in non-albicans species 4.
- Pregnancy: Certain treatments, such as fluconazole, ibrexafungerp, and intravaginal boric acid, should be avoided during pregnancy 4.
- Maintenance therapy: Maintenance therapy, such as weekly fluconazole or topical treatments, may be necessary to prevent recurrence 3, 4, 6.