What is the recommended treatment for a yeast infection in women?

Treatment for Yeast Infection in Women

For uncomplicated vulvovaginal candidiasis (VVC), first-line treatment options include either a single oral dose of fluconazole 150 mg or topical azole therapy for 1-7 days, both of which are equally effective with cure rates exceeding 90%. 1

Diagnosis Confirmation

Before treatment, ensure proper diagnosis through:

• Checking vaginal pH (normal pH 4.0-4.5 with yeast infection)
• Microscopy with KOH prep showing yeast/pseudohyphae
• Culture when indicated (especially for recurrent cases)

Common symptoms include:

• Vaginal itching (pruritus)
• Thick white discharge resembling cottage cheese
• Vaginal soreness or burning
• Dyspareunia (painful intercourse)
• External dysuria (painful urination)

Treatment Options

Topical Treatments

• Clotrimazole 1% cream: 5g intravaginally for 7-14 days 1, 2
• Clotrimazole 2% cream: 5g intravaginally for 3 days 2
• Miconazole 2% cream: 5g intravaginally for 7 days 1
• Miconazole 200 mg vaginal suppository: 1 suppository for 3 days 1
• Terconazole 0.4% cream: 5g intravaginally for 7 days 1
• Terconazole 0.8% cream: 5g intravaginally for 3 days 1
• Butoconazole 2% cream: 5g intravaginally for 3 days 1
• Tioconazole 6.5% ointment: 5g intravaginally as single application 1

Oral Treatment

• Fluconazole 150 mg: Single oral dose 1, 3, 4

Treatment Algorithm Based on Severity

1. Simple/Uncomplicated VVC

• Either single oral dose of fluconazole 150 mg OR
• Topical azole for 1-7 days
• Both approaches have similar efficacy with cure rates >90% 1

2. Moderate to Severe VVC

• Oral fluconazole 150 mg every 72 hours for 3 doses OR
• Extended course (7-14 days) of topical azole 1
• Evidence shows 7-day treatment is more effective than shorter courses 1

3. Recurrent VVC (4+ episodes per year)

• Initial induction therapy: Topical agent or oral fluconazole for 10-14 days 1
• Followed by maintenance therapy: Fluconazole 150 mg weekly for 6 months 1
• This maintenance approach significantly reduces recurrence rates 5

4. Non-albicans Candida Infections

• Longer duration therapy (7-14 days) with non-fluconazole azoles 5, 1
• For resistant cases (especially C. glabrata): Boric acid 600mg in gelatin capsule vaginally daily for 2 weeks 5, 1

Special Populations

Pregnant Women

• Only topical azole therapies applied for 7 days 5, 1
• Oral fluconazole should be avoided due to potential risk of spontaneous abortion 1
• Topical imidazoles are significantly more effective than nystatin during pregnancy 1

Immunocompromised Patients

• May require longer treatment courses 1
• For HIV-infected women, treatment should not differ from seronegative women, but non-albicans species may be more common 5

Important Considerations

• Asymptomatic colonization (10-20% of women normally harbor Candida) should not be treated 1
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1
• Partner treatment is not routinely recommended unless the male partner has symptomatic balanitis 5, 1
• Patients should return for medical evaluation if symptoms persist after 2 weeks of treatment 1
• Avoid potential irritants, wear cotton underwear, and use mild, fragrance-free cleansers 1

Treatment Failures

• If symptoms persist after initial therapy, consider:
  1. Longer duration of therapy
  2. Alternative antifungal agent
  3. Culture to identify non-albicans species
  4. Evaluation for underlying conditions (diabetes, immunosuppression)

Topical and oral treatments have similar efficacy rates, with studies showing single-dose oral fluconazole achieving 97% clinical cure rates at short-term follow-up and 88% at long-term assessment 4.