What is the treatment for vaginal yeast infections?

Treatment of Vaginal Yeast Infections

First-line treatment options for uncomplicated vaginal yeast infections include topical azole creams or suppositories for 1-7 days or fluconazole 150 mg as a single oral dose. 1

Diagnosis

Vaginal yeast infections (vulvovaginal candidiasis or VVC) are characterized by:

• Pruritus (itching) and erythema in the vulvovaginal area
• White discharge (may be thick like cottage cheese)
• Vaginal soreness, vulvar burning, dyspareunia, and external dysuria
• Normal vaginal pH (≤4.5)

Diagnosis can be confirmed by:

• Wet preparation or Gram stain showing yeasts or pseudohyphae
• Positive culture for yeast species
• Use of 10% KOH in wet preparations improves visualization of yeast 2

Treatment Options

Intravaginal Agents (OTC and Prescription)

• Butoconazole 2% cream 5g intravaginally for 3 days
• Clotrimazole 1% cream 5g intravaginally for 7-14 days
• Clotrimazole 100mg vaginal tablet for 7 days
• Clotrimazole 100mg vaginal tablet, two tablets for 3 days
• Clotrimazole 500mg vaginal tablet, single application
• Miconazole 2% cream 5g intravaginally for 7 days
• Miconazole 200mg vaginal suppository, one suppository for 3 days
• Miconazole 100mg vaginal suppository, one suppository for 7 days
• Terconazole 0.4% cream 5g intravaginally for 7 days
• Terconazole 0.8% cream 5g intravaginally for 3 days
• Terconazole 80mg vaginal suppository, one suppository for 3 days 2

Oral Agent

• Fluconazole 150mg oral tablet, single dose 2, 3

Treatment Selection Guidelines

1. Uncomplicated VVC (mild-to-moderate, sporadic, nonrecurrent disease in a normal host with normally susceptible C. albicans):

   • Any of the above treatments are effective, including short-term and single-dose therapies
   • Treatment with azoles results in relief of symptoms and negative cultures in 80-90% of patients 2

2. Complicated VVC (severe local or recurrent VVC in an abnormal host):

   • May require longer duration of therapy and closer monitoring 1
   • Diabetic or immunocompromised patients may need extended treatment 1

3. Pregnancy:

   • Use only topical azole therapies for 7 days
   • Avoid oral fluconazole due to potential risk of spontaneous abortion 1

4. Elderly patients:

   • May require longer treatment duration (7-14 days) due to reduced immune function and slower healing time 1

Special Considerations

• Self-medication with OTC preparations should only be advised for women previously diagnosed with VVC who have a recurrence of the same symptoms
• Any woman whose symptoms persist after using an OTC preparation or who has a recurrence within 2 months should seek medical care 2
• Identifying Candida by culture in the absence of symptoms should not lead to treatment, as 10-20% of women normally harbor Candida species in the vagina 2
• VVC can occur concomitantly with STDs or following antibacterial therapy 2

Prevention

• Using condoms correctly
• Avoiding irritants such as perfumed soaps and feminine hygiene products
• Using appropriate lubricants during sexual intercourse
• Wearing cotton underwear 1

Treatment Efficacy

Topical azole drugs are more effective than nystatin, with clinical cure rates of 80-90% for patients who complete therapy 2. Fluconazole is an oral drug of choice for treatment of vaginal yeast infection with minimal toxicity 4.

Remember that vaginal yeast infections do NOT cause fever, chills, lower abdominal pain, back or shoulder pain, foul-smelling discharge, or missed periods. These may be signs of other conditions requiring immediate medical attention 5.