What is the treatment for a vaginal yeast infection?

Treatment for Vaginal Yeast Infections

For uncomplicated vaginal yeast infections, both topical azole medications (applied intravaginally) and oral fluconazole 150 mg as a single dose are equally effective first-line treatments. 1

Diagnosis

Before initiating treatment, it's important to confirm the diagnosis of a vaginal yeast infection, characterized by:

• Pruritus (itching) in the vulvovaginal area
• White discharge (often thick, resembling cottage cheese)
• Vaginal soreness, irritation, or burning
• Dyspareunia (painful intercourse)
• External dysuria (pain when urine contacts irritated vulvar tissues)
• Normal vaginal pH (<4.5)

Diagnosis can be confirmed by:

• Wet preparation (saline, 10% KOH) or Gram stain showing yeasts or pseudohyphae
• Culture yielding a positive result for a yeast species 2

Treatment Options

First-Line Treatments

Intravaginal Azole Medications:

• Clotrimazole 1% cream 5g intravaginally for 7-14 days 2, 3
• Clotrimazole 100mg vaginal tablet for 7 days 2
• Clotrimazole 100mg vaginal tablet, two tablets for 3 days 2
• Clotrimazole 500mg vaginal tablet, one tablet in a single application 2
• Miconazole 2% cream 5g intravaginally for 7 days 2, 4
• Miconazole 200mg vaginal suppository for 3 days 2
• Miconazole 100mg vaginal suppository for 7 days 2
• Tioconazole 6.5% ointment 5g intravaginally in a single application 2
• Terconazole 0.4% cream 5g intravaginally for 7 days 2
• Terconazole 0.8% cream 5g intravaginally for 3 days 2
• Terconazole 80mg vaginal suppository for 3 days 2

Oral Option:

• Fluconazole 150mg oral tablet, one tablet in single dose 2, 5

Treatment Selection Considerations

1. Short-course topical formulations (single dose and 1-3 day regimens) effectively treat uncomplicated VVC 2

2. Topically applied azole drugs are more effective than nystatin, with relief of symptoms and negative cultures in 80-90% of patients who complete therapy 2

3. Single-dose oral fluconazole offers the convenience of one-time dosing with similar efficacy to topical treatments 1, 5

4. Over-the-counter (OTC) options include preparations for intravaginal administration of clotrimazole and miconazole, which can be recommended for women previously diagnosed with VVC who experience recurrence of the same symptoms 2

Special Considerations

Complicated VVC

For severe or complicated VVC, multi-day regimens (3-7 days) are preferred over single-dose treatments 1

Pregnancy

Only topical azole therapies should be used during pregnancy, with 7-day treatment courses recommended 1

Recurrent VVC

For women experiencing three or more episodes per year:

• Fluconazole 150mg weekly for 6 months is a recommended maintenance therapy 1
• Alternative maintenance regimens include clotrimazole 500mg vaginal suppositories once weekly 1

Important Cautions

1. Oil-based creams and suppositories may weaken latex condoms and diaphragms 2

2. Self-medication with OTC preparations should only be advised for women previously diagnosed with VVC who experience recurrence of the same symptoms 2

3. Persistent symptoms - Any woman whose symptoms persist after using an OTC preparation or who has a recurrence of symptoms within 2 months should seek medical care 2

4. Asymptomatic colonization - Identifying Candida in the absence of symptoms is not an indication for treatment, as approximately 10-20% of women harbor Candida species in the vagina normally 2

5. Concomitant STDs - VVC can occur alongside sexually transmitted diseases, and treatment of all pathogens present is warranted 2

Follow-up

Patients should return for follow-up only if symptoms persist or recur after treatment 1