What is the treatment for vaginal candidiasis?

Treatment for Vaginal Candidiasis

The first-line treatment for uncomplicated vaginal candidiasis is either a single 150 mg oral dose of fluconazole or topical azole therapy (such as clotrimazole, miconazole, or tioconazole) for 1-7 days. 1, 2

Treatment Options

Uncomplicated Vaginal Candidiasis

• Oral therapy:

  • Fluconazole 150 mg single oral dose 1, 2

• Topical therapy (7-day regimens):

  • Clotrimazole 1% cream applied intravaginally daily 1
  • Miconazole 2% cream applied intravaginally daily 1
  • Butaconazole vaginal cream 1
  • Tioconazole vaginal preparations 1

• Shorter topical regimens:

  • Clotrimazole: Two 100 mg tablets daily for 3 days (shown to be as effective as 7-day regimen) 3

Recurrent Vulvovaginal Candidiasis (RVVC)

For women with 4 or more episodes per year:

1. Initial intensive therapy:

   • Longer duration of initial therapy (7-14 days of topical therapy or fluconazole 150 mg oral dose, repeated 3 days later) 1

2. Maintenance therapy (for 6 months):

   • Clotrimazole 500 mg vaginal suppositories once weekly 1
   • Fluconazole 100-150 mg oral dose once weekly 1
   • Ketoconazole 100 mg daily (monitor for hepatotoxicity) 1
   • Itraconazole 400 mg once monthly or 100 mg daily 1

Special Considerations

Non-albicans Candida Species

• Found in 10-20% of RVVC cases 1
• C. glabrata and other non-albicans species may be less responsive to conventional azole therapies 1
• Consider longer duration of therapy or alternative antifungal agents

Patient Populations

Pregnant Women

• Use only topical azole therapies for 7 days 4
• Avoid oral fluconazole due to potential risk of spontaneous abortion 4

Diabetic Patients

• May require more aggressive treatment and closer follow-up 4

Immunocompromised Patients

• Need longer duration of therapy and more frequent monitoring 4

Patient Education and Self-Care

• OTC preparations should only be used by women previously diagnosed with VVC who have recurrence of the same symptoms 1
• Women should seek medical care if:
  • Symptoms persist after using OTC preparations
  • Symptoms recur within 2 months 1
• Hygiene recommendations:
  • Keep genital area clean and dry
  • Wear loose-fitting cotton underwear
  • Avoid irritants like perfumed soaps 4

Follow-Up

• Patients should return for follow-up only if:
  • Symptoms persist
  • Symptoms recur within 2 months of initial treatment 1

Common Pitfalls

1. Unnecessary or inappropriate use of OTC preparations can delay proper diagnosis and treatment of other vulvovaginitis etiologies 1

2. Inadequate treatment duration for recurrent infections - RVVC requires longer initial therapy followed by maintenance therapy 1

3. Failure to identify non-albicans species - consider culture for persistent or recurrent cases to identify unusual species that may be less responsive to standard treatments 1

4. Drug interactions with oral azoles - oral agents like fluconazole may interact with medications including astemizole, calcium channel antagonists, cisapride, coumadin, cyclosporin A, oral hypoglycemic agents, phenytoin, protease inhibitors, tacrolimus, terfenadine, theophylline, trimetrexate, and rifampin 1

5. Treatment of sexual partners - generally not recommended for uncomplicated VVC but may be considered for women with recurrent infection 1