What is the recommended treatment for vaginal yeast infection?

Treatment for Vaginal Yeast Infection

For vaginal yeast infections, first-line treatment includes topical azole medications (such as clotrimazole, miconazole) applied intravaginally for 1-7 days or a single oral dose of fluconazole 150 mg. 1

Treatment Options

First-line Treatments:

Intravaginal Azole Options:

• Clotrimazole

  • 1% cream: 5g intravaginally for 7-14 days
  • 100 mg vaginal tablet: daily for 7 days
  • 100 mg vaginal tablet: two tablets for 3 days
  • 500 mg vaginal tablet: single application

• Miconazole

  • 2% cream: 5g intravaginally for 7 days
  • 200 mg vaginal suppository: daily for 3 days
  • 100 mg vaginal suppository: daily for 7 days

• Other Topical Options:

  • Butoconazole 2% cream: 5g intravaginally for 3 days
  • Terconazole 0.4% cream: 5g intravaginally for 7 days
  • Terconazole 0.8% cream: 5g intravaginally for 3 days
  • Terconazole 80 mg vaginal suppository: daily for 3 days
  • Tioconazole 6.5% ointment: 5g intravaginally in a single application
  • Nystatin 100,000-unit vaginal tablet: daily for 14 days

Oral Option:

• Fluconazole 150 mg oral tablet: single dose 1

Treatment Selection Considerations

1. Uncomplicated VVC (mild-to-moderate, sporadic, non-recurrent disease in normal host with C. albicans):

   • Any of the above treatments are effective, including short-term and single-dose therapies 1
   • Success rates of 80-90% for patients who complete therapy 1

2. Complicated VVC (severe local or recurrent VVC in abnormal host or infection with less susceptible Candida species):

   • May require longer treatment duration
   • For severe cases, consider miconazole nitrate vaginal suppository 1,200 mg or two doses of fluconazole 150 mg 2

3. Recurrent VVC (≥4 episodes in 12 months):

   • After initial therapy, consider maintenance therapy
   • Fluconazole 150 mg weekly for 6 months has shown efficacy 3
   • Alternative: vaginal nystatin suppositories for 14 days each month 3

Important Clinical Considerations

• Self-medication with OTC preparations should only be advised for women previously diagnosed with VVC who experience recurrence of the same symptoms 1
• Persistent symptoms after OTC treatment or recurrence within 2 months requires medical evaluation 1
• During menstruation: Treatment can be continued during menstrual periods; avoid tampons as they may remove medication from the vagina 4
• Avoid concurrent use of other vaginal products (douches, tampons, spermicides) during treatment 4
• Avoid sexual intercourse during treatment with vaginal preparations 4

Risk Factors for Recurrent Infections

• Hormonal changes before menstrual periods
• Antibiotic use
• Certain birth control pills
• Pregnancy
• Diabetes
• Tight or moist clothing
• Weakened immune system 4

Prevention Strategies

• Keep genital area cool and dry
• Wear cotton underwear and loose-fitting clothes
• Change out of damp clothes or wet bathing suits promptly
• Change minipads frequently when not menstruating
• Wipe from front to back after bowel movements 4, 5

Special Considerations

• Pregnancy: Consult healthcare provider before using fluconazole as it may not be appropriate during pregnancy 5
• Drug interactions: Fluconazole may interact with other medications including warfarin, quinidine, erythromycin, and pimozide 5
• Non-albicans Candida infections: Nystatin may be more effective than fluconazole for C. glabrata infections 3

Vaginal yeast infections are not typically sexually transmitted, but partners may occasionally develop symptoms and require treatment 4.