Treatment Options for Vaginal Itching
For vaginal itching caused by vulvovaginal candidiasis (VVC), topical azole medications or oral fluconazole are the treatments of choice, with both approaches showing 80-90% effectiveness in relieving symptoms and producing negative cultures. 1
Diagnostic Considerations
Before initiating treatment, proper diagnosis is essential:
- Vulvovaginal candidiasis is suggested by pruritus and erythema in the vulvovaginal area, often with white discharge 1
- Diagnosis is confirmed when either:
- Wet preparation or Gram stain shows yeasts or pseudohyphae, or
- Culture or other test yields positive result for yeast species 1
- VVC is associated with normal vaginal pH (≤4.5) 1
- Using 10% KOH in wet preparations improves visualization of yeast and mycelia 1
Treatment Options
Recommended Regimens for Uncomplicated VVC
Intravaginal Agents:
- Butoconazole 2% cream 5g intravaginally for 3 days 1
- Clotrimazole 1% cream 5g intravaginally for 7-14 days 1
- Clotrimazole 100mg vaginal tablet for 7 days 1
- Clotrimazole 100mg vaginal tablet, two tablets for 3 days 1
- Clotrimazole 500mg vaginal tablet, one tablet in a single application 1
- Miconazole 2% cream 5g intravaginally for 7 days 1
- Miconazole 200mg vaginal suppository, one suppository for 3 days 1
- Miconazole 100mg vaginal suppository, one suppository for 7 days 1
- Tioconazole 6.5% ointment 5g intravaginally in a single application 1
- Terconazole 0.4% cream 5g intravaginally for 7 days 1
- Terconazole 0.8% cream 5g intravaginally for 3 days 1
- Terconazole 80mg vaginal suppository, one suppository for 3 days 1
Oral Agent:
- Fluconazole 150mg oral tablet, one tablet in single dose 1
Treatment Selection Based on VVC Classification
Uncomplicated VVC (mild-to-moderate, sporadic, nonrecurrent disease in normal host with C. albicans):
Complicated VVC (severe local or recurrent VVC in abnormal host, or infection by less susceptible fungal pathogen like C. glabrata):
Special Considerations
Over-the-Counter (OTC) Treatment
- Preparations for intravaginal administration of butoconazole, clotrimazole, miconazole, and tioconazole are available OTC 1
- Self-medication with OTC preparations should be advised only for women previously diagnosed with VVC who experience recurrence of the same symptoms 1
- Any woman whose symptoms persist after using an OTC preparation or who has symptom recurrence within 2 months should seek medical care 1
Important Precautions
- Oil-based creams and suppositories might weaken latex condoms and diaphragms 1
- Topical agents usually cause no systemic side effects, though local burning or irritation may occur 1
- Oral agents occasionally cause nausea, abdominal pain, and headache 1
- Oral azoles may have clinically important interactions with other medications 1
Recurrent VVC
- Defined as 4 or more episodes per year 2
- For recurrent VVC, maintenance therapy with weekly oral fluconazole for up to 6 months enhances treatment success 2
Follow-Up
- Patients should return for follow-up visits only if symptoms persist or recur within 2 months of onset of initial symptoms 1
- Test of cure is not routinely recommended 1
Management of Sexual Partners
- VVC is not usually acquired through sexual intercourse; treatment of sex partners is not routinely recommended 1
- May be considered for women who have recurrent infection 1
- Male partners with balanitis (erythematous areas on glans with pruritus/irritation) may benefit from topical antifungal treatment 1
Comparative Effectiveness
- Studies show that oral fluconazole (single 150mg dose) is as effective as 7-day intravaginal clotrimazole therapy 3
- A three-day course of two clotrimazole vaginal tablets daily is as effective as one tablet daily for seven days 4
- Clotrimazole 1% vaginal cream for seven days has shown comparable or slightly better efficacy than miconazole 2% vaginal cream for 14 days 5