What is the treatment for a vaginal yeast infection?

Treatment for Vaginal Yeast Infection

For uncomplicated vaginal yeast infections, first-line treatment options include either a single dose of oral fluconazole 150 mg or topical azole therapy (clotrimazole, miconazole, or butoconazole) for 1-7 days. 1

Diagnosis

Before initiating treatment, confirm the diagnosis with:

• Characteristic symptoms: vaginal itching, burning, irritation, white "cottage cheese-like" discharge
• Physical findings: vulvar erythema and swelling
• Normal vaginal pH (<4.5)
• Microscopic examination with 10% KOH preparation to visualize yeast/pseudohyphae 1

Treatment Algorithm

Uncomplicated VVC (mild-to-moderate, sporadic, non-recurrent)

• Oral option:

  • Fluconazole 150 mg oral tablet, single dose 2, 1

• Topical options:

  • Clotrimazole 1% cream for 7-14 days or 100 mg vaginal tablet for 7 days 2, 3
  • Miconazole 2% cream for 7 days or 200 mg vaginal suppository for 3 days 2, 4
  • Butoconazole 2% cream for 3 days 2
  • Terconazole 0.4% cream for 7 days or 0.8% cream for 3 days 2
  • Tioconazole 6.5% ointment, single application 2

Complicated VVC

Severe VVC (extensive vulvar erythema, edema, excoriation, fissure formation)

• Fluconazole 150 mg in two sequential doses (second dose 72 hours after initial dose) 2
• OR 7-14 days of topical azole therapy 2, 1

Recurrent VVC (≥4 episodes in 12 months)

1. Initial treatment: 7-14 days of topical therapy or fluconazole 150 mg repeated after 3 days 2
2. Maintenance regimen for 6 months:
   • Fluconazole 100-150 mg once weekly 2, 1
   • OR Clotrimazole 500 mg vaginal suppository once weekly 2

Non-albicans VVC

• 7-14 days of non-fluconazole azole therapy 2
• If recurrence: boric acid 600 mg in gelatin capsule vaginally once daily for 2 weeks 2, 1

Special Considerations

Pregnancy

• Only topical azole therapies should be used (clotrimazole, miconazole, butoconazole, terconazole) 2, 1
• Treatment duration should be 7 days 1
• Oral fluconazole is contraindicated due to potential risk of spontaneous abortion and birth defects 1, 5

HIV Infection

• Women with HIV should receive the same treatment as those without HIV 2, 1
• VVC in HIV-positive women responds similarly to standard treatment regimens 1

Over-the-Counter Treatment

• Self-medication with OTC preparations should only be used by women previously diagnosed with VVC who experience identical symptoms 2, 1
• Women whose symptoms persist after OTC treatment or who experience recurrence within 2 months should seek medical care 2, 1

Treatment Efficacy and Side Effects

• Both oral fluconazole and topical azoles have 80-90% cure rates 1
• Topical agents usually cause minimal systemic side effects but may cause local burning or irritation 2
• Oral azoles may occasionally cause nausea, abdominal pain, and headache 2
• Fluconazole may interact with other medications including statins, tricyclics, and certain cardiac medications 5

Prevention

• Wear cotton underwear and loose-fitting clothing
• Change out of wet clothing promptly
• Avoid douching and scented feminine hygiene products
• Maintain good perineal hygiene 1

Remember that identifying Candida in asymptomatic women should not lead to treatment, as 10-20% of women normally harbor Candida species in the vagina 1.