What is the treatment for a vaginal yeast infection?

Treatment for Vaginal Yeast Infections

Topical azole formulations and oral fluconazole are equally effective first-line treatments for uncomplicated vaginal yeast infections, with clinical cure rates of approximately 80%. 1

Diagnosis

Before initiating treatment, confirm diagnosis through:

• Symptoms (itching, burning, redness, soreness)
• White vaginal discharge resembling cottage cheese
• Normal vaginal pH (≤4.5)
• Microscopic examination with 10% KOH preparation showing yeast or pseudohyphae 1

Treatment Options

First-Line Treatments for Uncomplicated VVC

Topical Azole Options:

• Clotrimazole 1% cream: 5g intravaginally for 7-14 days 2, 1
• Clotrimazole 2% cream: 5g intravaginally for 3 days 1
• Miconazole 2% cream: 5g intravaginally for 7 days 2, 1
• Miconazole 4% cream: 5g intravaginally for 3 days 1
• Miconazole 100mg vaginal suppository: daily for 7 days 2, 1
• Miconazole 200mg vaginal suppository: daily for 3 days 2, 1
• Tioconazole 6.5% ointment: 5g intravaginally as single dose 2, 3
• Terconazole 0.4% cream: 5g intravaginally for 7 days 2, 1
• Terconazole 0.8% cream: 5g intravaginally for 3 days 2, 1
• Butoconazole 2% cream: 5g intravaginally for 3 days or as single-dose bioadhesive product 2, 1

Oral Option:

• Fluconazole 150mg: single oral dose 2, 4

Treatment Selection Considerations:

• Single-dose treatments are appropriate for mild-to-moderate cases 2
• Multi-day regimens (3-7 days) are preferred for severe cases 2, 1
• Patient preference may guide choice between oral and topical options 1
• Avoid oral fluconazole in first trimester of pregnancy 1

Over-the-Counter Treatment

Many topical azoles (miconazole, clotrimazole) are available over-the-counter 2. Self-medication should only be advised for:

• Women previously diagnosed with VVC
• Women experiencing recurrence of the same symptoms 2, 1

Women should seek medical care if:

• Symptoms persist after using OTC preparation
• Symptoms recur within 2 months 2

Treatment for Recurrent VVC

For women with recurrent VVC (defined as ≥3 episodes in 12 months) 2:

1. Initial treatment: 10-14 days of induction therapy with topical agent or oral fluconazole 1
2. Maintenance therapy: Fluconazole 150mg weekly for 6 months 1, 5

A clinical trial demonstrated that weekly fluconazole maintenance therapy kept 90.8% of women disease-free at 6 months compared to only 35.9% with placebo 5. However, after stopping maintenance therapy, recurrence rates increased, with only 42.9% remaining disease-free at 12 months 5.

Alternative Treatments for Resistant Cases

For non-albicans Candida species or resistant infections:

• Boric acid 600mg daily intravaginally for 14 days 1
• Nystatin intravaginal suppositories 100,000 units daily for 14 days 1

Follow-Up

• No routine follow-up needed if symptoms resolve 2, 1
• Return for evaluation if symptoms persist after treatment 2, 1

Important Considerations

• Treatment of sexual partners is not recommended for typical cases, as VVC is not usually sexually transmitted 2
• Male partners with balanitis (erythema and irritation of the glans penis) may benefit from topical antifungal treatment 2
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 2
• Non-albicans Candida species (particularly C. glabrata) may be resistant to azoles and require alternative treatments 1
• Vaginal pH is typically normal (≤4.5) in yeast infections, which helps differentiate from bacterial vaginosis 1

Prevention Strategies

• Good genital hygiene
• Cotton underwear
• Avoiding perfumed soaps and bubble baths 1