Treatment of Folliculitis on the Vagina
For vaginal folliculitis, topical antifungal treatments are the first-line therapy, with options including clotrimazole 1% cream applied intravaginally for 7-14 days or fluconazole 150 mg as a single oral dose. 1
Diagnosis
- Folliculitis on the vagina typically presents with symptoms including pruritus, erythema, and sometimes a white discharge 1
- Diagnosis can be confirmed when a woman has signs and symptoms of inflammation and when either:
- A wet preparation (saline, 10% KOH) or Gram stain of vaginal discharge demonstrates yeasts or pseudohyphae, or
- A culture or other test yields a positive result for a yeast species 1
- Vaginal pH is typically normal (<4.5) in cases of fungal folliculitis 1
Treatment Options
Topical Treatments (First-Line)
- Azole creams and suppositories (more effective than nystatin) 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 100mg vaginal suppository, one suppository for 7 days 1
- Miconazole 200mg vaginal suppository, one suppository for 3 days 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 single dose 1
Treatment Selection Guidelines
- For uncomplicated cases: Short-course topical formulations (1-3 days) or single-dose oral fluconazole 1
- For complicated cases: Multi-day regimens (7 days) are preferred 1
- For recurrent cases: Initial treatment with 7-14 days of topical therapy or fluconazole 150mg repeated after 3 days, followed by maintenance therapy 1
Important Considerations
- Many topical preparations (creams and suppositories) are oil-based and may weaken latex condoms and diaphragms 1
- Several over-the-counter options are available (butoconazole, clotrimazole, miconazole, tioconazole) 1
- Self-medication with OTC preparations should only be advised for women who have been previously diagnosed with vulvovaginal candidiasis and experience a recurrence of the same symptoms 1
- Any woman whose symptoms persist after using an OTC preparation or who experiences a recurrence of symptoms within 2 months should seek medical care 1
Follow-Up
- Patients should return for follow-up visits only if symptoms persist or recur within 2 months of onset of initial symptoms 1
- Treatment of sexual partners is not routinely recommended as vulvovaginal candidiasis is not usually sexually transmitted 1
Special Populations
- Pregnancy: Only topical azoles are recommended during pregnancy; oral fluconazole should be avoided 2
- Recurrent infections: May require maintenance therapy for 6 months with weekly fluconazole (150mg) or daily topical azole therapy 1
- Non-albicans Candida infections: May require alternative treatments as they respond less well to conventional azole therapy 1