What are the treatment options for vaginal itching?

Treatment Options for Vaginal Itching

Azole antifungals remain the treatment of choice for vulvovaginal candidiasis (VVC), the most common cause of vaginal itching, with both topical and oral options available depending on the severity and type of infection. 1

Common Causes of Vaginal Itching

• Vulvovaginal candidiasis (VVC) is one of the most common causes, affecting 70-75% of women during their lifetime and accounting for 20-25% of vaginitis cases 1, 2
• Bacterial vaginosis (BV) accounts for 40-50% of vaginitis cases 2
• Trichomoniasis is responsible for 15-20% of vaginitis cases 2
• Non-infectious causes (atrophic, irritant, allergic, inflammatory vaginitis) account for 5-10% of cases 2

Treatment for Vulvovaginal Candidiasis (VVC)

Uncomplicated VVC

For sporadic, mild-to-moderate infections in non-immunocompromised women:

• Topical azole options (80-90% effective) 1:

  • Clotrimazole 1% cream 5g intravaginally for 7-14 days 1, 3
  • Clotrimazole 2% cream 5g intravaginally for 3 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 100mg vaginal suppository, one suppository for 7 days 1
  • Miconazole 200mg vaginal suppository, one suppository for 3 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 option:

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

Complicated VVC

For recurrent (≥4 episodes/year), severe infections, or in special populations:

• Initial therapy: Longer duration of azole treatment (7-14 days) 1

• Maintenance therapy for recurrent VVC: After 2 weeks of induction therapy, maintenance for 6 months with:

  • Fluconazole 150mg orally weekly 1
  • Ketoconazole 100mg daily 1
  • Itraconazole 100mg every other day 1
  • Daily therapy with any topical azole 1

• For non-albicans Candida species:

  • Boric acid 600mg in gelatin capsule vaginally daily for 14 days 1

Treatment for Bacterial Vaginosis

• Oral metronidazole 1
• Intravaginal metronidazole 2
• Intravaginal clindamycin 2

Treatment for Trichomoniasis

• Oral metronidazole (single 2g dose or 7-day course) 1, 4
• Oral tinidazole 2
• Treatment of sexual partners is recommended 1, 2

Non-infectious Causes of Vaginal Itching

• Atrophic vaginitis: Hormonal and non-hormonal therapies 2
• Inflammatory vaginitis: Topical clindamycin and steroids 2
• Contact dermatitis: Eliminate irritants and restore epidermal barrier function 5

Important Considerations

• Pregnancy: Only topical azole therapies are recommended; fluconazole may be associated with spontaneous abortion and birth defects 1
• HIV infection: Treatment measures are identical to those for women without HIV infection 1
• Self-diagnosis caution: Self-diagnosis of yeast vaginitis is often unreliable; incorrect diagnosis can lead to overuse of antifungal agents and subsequent irritant dermatitis 1, 3
• When to seek medical care: Women should see a doctor if:
  • Symptoms persist after using OTC preparations 1, 3
  • Symptoms recur within 2 months 1, 3
  • First-time vaginal itching and discomfort 3
  • Symptoms accompanied by fever, abdominal pain, or foul-smelling discharge 3
  • Frequent vaginal yeast infections (≥3 in 6 months) 3

Treatment Approach Algorithm

1. Identify the likely cause based on symptoms:

   • Itching with white discharge: Consider VVC 1
   • Fishy odor with thin discharge: Consider BV 2
   • Yellow-green discharge with irritation: Consider trichomoniasis 6

2. For suspected VVC:

   • If first episode or infrequent: Use short-course topical azole or single-dose oral fluconazole 1
   • If recurrent: Use longer initial therapy followed by maintenance regimen 1
   • If pregnant: Use only topical azoles for 7 days 1

3. For treatment failure:

   • Consider alternative diagnosis 4
   • For non-albicans Candida: Consider boric acid therapy 1
   • For recurrent infections: Consider extended maintenance therapy 1