What is the treatment for a vaginal yeast infection?

Treatment for Vaginal Yeast Infection

For uncomplicated vaginal yeast infections, treatment with either topical azole medications for 1-7 days or a single oral dose of fluconazole 150 mg is highly effective, with both approaches providing relief of symptoms and negative cultures in 80-90% of patients. 1

First-Line Treatment Options

Topical Treatments

• 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 as 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 Treatment

• Fluconazole 150mg oral tablet, one tablet in a single dose 1, 2

Treatment Selection Algorithm

For Uncomplicated Infections (mild-to-moderate symptoms, infrequent episodes):

• Single-dose treatments or short-course (1-3 days) therapies are appropriate 1
• Patient preference can guide choice between topical and oral options 1
• Oral fluconazole offers convenience of single-dose administration 2

For Complicated Infections (severe symptoms, recurrent episodes):

• Multi-day regimens (3-7 days) are preferred 1
• For severe cases, consider 7-14 day treatment courses 1
• For recurrent infections (≥3 episodes per year), evaluation for predisposing conditions is warranted 1

Important Clinical Considerations

• Diagnosis should be confirmed by symptoms (pruritus, erythema, white discharge) plus microscopic examination or culture showing yeast 1
• Vaginal pH should be normal (≤4.5) in cases of candida vaginitis 1
• Topical azole medications are more effective than nystatin 1, 3
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1
• Over-the-counter preparations (miconazole, clotrimazole) are appropriate for women with previously diagnosed yeast infections experiencing recurrence of the same symptoms 1

Special Populations

Pregnancy

• Only topical azole therapies should be used during pregnancy 1
• Clotrimazole, miconazole, butoconazole, and terconazole have been studied in pregnant women 1
• Many experts recommend 7-day therapy during pregnancy 1

HIV Infection

• Women with HIV infection and acute VVC should receive the same treatment regimens as HIV-negative women 1

Common Pitfalls to Avoid

• Treating asymptomatic colonization: 10-20% of women normally harbor Candida species in the vagina without symptoms and do not require treatment 1
• Inadequate follow-up: Patients should return if symptoms persist after treatment or recur within 2 months 1
• Unnecessary partner treatment: VVC is not typically sexually transmitted, so routine treatment of partners is not warranted 1
• Misdiagnosis: Other vaginal infections may present with similar symptoms; confirm diagnosis before treatment 1
• Inappropriate self-treatment: Women should seek medical care if symptoms persist after using OTC preparations or if symptoms recur within 2 months 1