What is the treatment for vaginal candida?

Treatment of Vaginal Candidiasis

For uncomplicated vaginal candidiasis, either a single 150-mg oral dose of fluconazole or topical antifungal agents applied for 1-7 days are strongly recommended as first-line treatments, with no one agent being superior to another. 1

Classification of Vaginal Candidiasis

Vaginal candidiasis can be classified as:

1. Uncomplicated (90% of cases):

   • Mild to moderate symptoms
   • Infrequent episodes
   • Likely caused by C. albicans
   • Occurs in non-immunocompromised patients

2. Complicated (10% of cases):

   • Severe symptoms
   • Recurrent episodes (≥4 episodes in 12 months)
   • Caused by non-albicans species
   • Occurs in abnormal hosts (diabetic, immunocompromised)

Treatment Recommendations

Uncomplicated Vaginal Candidiasis

• Oral option: Fluconazole 150 mg as a single dose 1
• Topical options: (applied for 1-7 days depending on formulation) 1
  • Clotrimazole 1% cream (2-3 times daily for 7-14 days)
  • Miconazole 2% cream (2-3 times daily for 7 days)
  • Butoconazole 2% cream (once daily for 3 days)
  • Terconazole vaginal cream

Severe Acute Vaginal Candidiasis

• Fluconazole 150 mg every 72 hours for a total of 2-3 doses 1

C. glabrata Infections (resistant to azoles)

1. Topical boric acid 600 mg in gelatin capsule, daily for 14 days 1
2. Nystatin intravaginal suppositories, 100,000 units daily for 14 days 1
3. Topical 17% flucytosine cream alone or with 3% AmB cream daily for 14 days 1

Recurrent Vulvovaginal Candidiasis

1. Induction phase: 10-14 days of topical agent or oral fluconazole
2. Maintenance phase: Fluconazole 150 mg weekly for 6 months 1, 2

Efficacy Considerations

• Clinical trials show that both oral fluconazole and topical antifungal treatments achieve comparable results with therapeutic cure rates of approximately 55% 3
• For acute vaginitis (<4 episodes/12 months), both treatment approaches achieve about 80% clinical cure and 67% mycologic eradication 3
• For recurrent vaginitis (≥4 episodes/12 months), cure rates are lower: 57% clinical cure and 47% mycologic eradication 3
• Long-term weekly fluconazole treatment for recurrent cases can significantly reduce recurrence rates, with 90.8% of women remaining disease-free at 6 months compared to 35.9% with placebo 2

Side Effects and Considerations

Oral Fluconazole

• Common side effects: headache (13%), nausea (7%), abdominal pain (6%), diarrhea (3%) 3
• Rare but serious: hepatic reactions, anaphylaxis 3

Topical Treatments

• Generally fewer systemic side effects
• Local reactions: burning, itching, irritation 4
• Terconazole side effects may include headache (26%), body pain (2.1%), fever (1.7%) 4

Special Situations

• Pregnancy: Topical azoles are preferred over oral agents
• Diabetes: Control of underlying diabetes is important for effective treatment and prevention of recurrence
• Immunosuppression: May require longer treatment courses

Prevention Strategies

• Good hygiene practices
• Avoiding tight-fitting clothing
• Wearing cotton underwear
• Controlling underlying conditions like diabetes

The 2016 Infectious Diseases Society of America guidelines provide the most recent and highest quality evidence for treatment of vaginal candidiasis, supporting both topical antifungal agents and oral fluconazole as effective first-line treatments for uncomplicated cases 1.