What is the treatment for vaginitis yeast infection?

Treatment for Vulvovaginal Candidiasis (Yeast Infection)

For uncomplicated vulvovaginal candidiasis (VVC), both topical azole preparations and oral fluconazole 150 mg as a single dose are highly effective first-line treatments with cure rates of 80-90%. 1

Classification of Vulvovaginal Candidiasis

VVC can be classified into two categories which guide treatment approach:

1. Uncomplicated VVC (90% of cases):

   • Mild-to-moderate symptoms
   • Sporadic, infrequent episodes
   • Likely caused by C. albicans
   • In immunocompetent patients

2. Complicated VVC (10% of cases):

   • Severe symptoms
   • Recurrent episodes (≥4 episodes/year)
   • Non-albicans Candida species
   • Abnormal host factors (diabetes, immunosuppression, pregnancy)

Treatment Options for Uncomplicated VVC

Topical Intravaginal Agents:

• Clotrimazole:

  • 1% cream 5g intravaginally for 7-14 days 1, 2
  • 100mg vaginal tablet for 7 days 1
  • 100mg vaginal tablet, two tablets for 3 days 1
  • 500mg vaginal tablet, single application 1

• Miconazole:

  • 2% cream 5g intravaginally for 7 days 1, 3
  • 200mg vaginal suppository, one suppository for 3 days 1
  • 100mg vaginal suppository, one suppository for 7 days 1
  • 1200mg vaginal insert, single dose 3

• Other topical options:

  • Butoconazole 2% cream 5g intravaginally for 3 days 1
  • Tioconazole 6.5% ointment 5g intravaginally in a single application 1
  • Terconazole 0.4% cream 5g intravaginally for 7 days 1
  • Terconazole 0.8% cream 5g intravaginally for 3 days 1
  • Terconazole 80mg vaginal suppository, one suppository for 3 days 1
  • Nystatin 100,000-unit vaginal tablet, one tablet for 14 days 1

Oral Agent:

• Fluconazole 150mg oral tablet, single dose 1, 4, 5

Treatment for Complicated VVC

Severe VVC:

• Fluconazole 150mg, two sequential doses given 3 days apart 6
• OR extended duration of topical therapy (7-14 days)

Recurrent VVC:

1. Induction phase:

   • Fluconazole 150mg every 72 hours for 3 doses (days 1,4, and 7) 1
   • OR 14 days of topical therapy

2. Maintenance phase:

   • Fluconazole 150mg weekly for 6 months 1
   • OR ketoconazole 100mg daily 1
   • OR itraconazole 100mg every other day 1
   • OR daily therapy with any topical azole 1

Non-albicans Candida:

• Boric acid 600mg in gelatin capsule intravaginally daily for 14 days 1
• OR topical flucytosine 1

Treatment Efficacy

• Single-dose oral fluconazole (150mg) is as effective as 7-day regimens of intravaginal clotrimazole, with clinical cure rates of 94% and 97% respectively at 14 days post-treatment 5
• For severe VVC, a two-dose regimen of fluconazole (150mg given 3 days apart) achieves significantly higher clinical cure rates compared to a single dose 6
• Patient preference often favors oral therapy, with 73% of patients preferring oral treatment over intravaginal options 7

Important Considerations

• Self-medication with OTC preparations should only be advised for women previously diagnosed with VVC who have a recurrence of the same symptoms 1
• Women whose symptoms persist after using an OTC preparation or who have a recurrence within 2 months should seek medical care 1
• Non-albicans Candida infections respond poorly to azole therapy and may require alternative treatments 6
• 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 1

Follow-up

• Patients should see improvement within 2-3 days of starting treatment
• If symptoms persist after completing therapy, reevaluation is necessary to confirm diagnosis and rule out other causes of vaginal symptoms