Treatment of Vaginal Candidiasis with White Discharge and Dryness
Vaginal candidiasis with symptoms of white discharge and dryness should be treated with either a topical azole antifungal or oral fluconazole, with both options providing effective relief in 80-90% of uncomplicated cases. For uncomplicated vulvovaginal candidiasis presenting with white discharge and dryness, either a single 150 mg oral dose of fluconazole or a course of topical azole therapy is recommended as first-line treatment. 1
Diagnosis
Before initiating treatment, confirm the diagnosis of vulvovaginal candidiasis (VVC):
- VVC is characterized by pruritus, white discharge, vaginal soreness, vulvar burning, dyspareunia, and external dysuria 1
- Diagnosis is confirmed when a woman has symptoms of vaginitis plus either:
- Wet preparation or Gram stain showing yeasts/pseudohyphae, or
- Positive culture for yeast species 1
- VVC is associated with a normal vaginal pH (≤4.5) 1
- Using 10% KOH in wet preparations improves visualization of yeast and mycelia 1
Treatment Options
Recommended Topical Treatments
Over-the-counter intravaginal agents:
- Clotrimazole 1% cream: 5g intravaginally daily for 7-14 days 1
- Clotrimazole 2% cream: 5g intravaginally daily for 3 days 1
- Miconazole 2% cream: 5g intravaginally daily for 7 days 1
- Miconazole 4% cream: 5g intravaginally daily for 3 days 1
- Miconazole 100mg vaginal suppository: One daily for 7 days 1
- Miconazole 200mg vaginal suppository: One daily for 3 days 1
- Miconazole 1200mg vaginal suppository: One single application 1
- Tioconazole 6.5% ointment: 5g intravaginally in a single application 1
Prescription intravaginal agents:
Oral Treatment
- Fluconazole 150mg: Single oral dose 1, 2
- Clinical studies have shown that a single oral dose of fluconazole is as effective as multi-day topical treatments 3
Treatment Selection Considerations
- Efficacy: Both topical azoles and oral fluconazole provide relief of symptoms and negative cultures in 80-90% of patients who complete therapy 1
- Convenience: Single-dose oral fluconazole offers greater convenience compared to multi-day topical treatments 3, 4
- Side effects: Fluconazole may cause more gastrointestinal side effects (nausea, abdominal pain) compared to topical treatments 2
- Severity: Single-dose treatments are appropriate for mild-to-moderate cases, while multi-day regimens (3-day and 7-day) are preferred for severe or complicated VVC 1
Special Considerations
- Recurrent VVC: Women with recurrent VVC (≥4 episodes/12 months) have lower cure rates with standard therapy and may require longer treatment courses 2, 1
- Pregnancy: Topical azoles are generally preferred during pregnancy 1
- HIV infection: Patients with HIV should receive the same treatment as those without HIV 1
- Self-medication: Self-medication with OTC preparations should only be advised for women previously diagnosed with VVC who experience recurrence of the same symptoms 1
Follow-up
- Patients should return for follow-up only if symptoms persist after completing treatment or if symptoms recur within 2 months 1
- Any woman whose symptoms persist after using an OTC preparation or who experiences recurrence within 2 months should seek medical care 1
Prevention of Recurrence
- Keep the genital area cool and dry, as yeast grow well in warm, moist areas 5
- Wear cotton underwear and loose-fitting clothes 5
- Change out of damp clothes or wet bathing suits promptly 5
- If using minipads when not menstruating, change them frequently 5
- Discuss with your doctor any medications you're taking, as certain drugs like antibiotics, steroids, or birth control pills may increase risk of VVC 5