What is the typical treatment for a yeast infection?

Treatment of Yeast Infections

For typical vaginal yeast infections (vulvovaginal candidiasis), treatment with topical azole antifungals or oral fluconazole is highly effective, with cure rates of 80-90% for uncomplicated cases. 1

First-Line Treatment Options

Topical Treatments

• Butoconazole 2% cream: Apply 5g intravaginally for 3 days 1
• Clotrimazole 1% cream: Apply 5g intravaginally for 7-14 days 1
• Clotrimazole 100mg vaginal tablet: Insert one tablet daily for 7 days 1
• Clotrimazole 100mg vaginal tablet: Insert two tablets daily for 3 days 1
• Clotrimazole 500mg vaginal tablet: Insert as a single application 1, 2
• Miconazole 2% cream: Apply 5g intravaginally for 7 days 1
• Miconazole 200mg vaginal suppository: Insert one suppository daily for 3 days 1
• Miconazole 100mg vaginal suppository: Insert one suppository daily for 7 days 1
• Terconazole 0.4% cream: Apply 5g intravaginally for 7 days 1
• Terconazole 0.8% cream: Apply 5g intravaginally for 3 days 1
• Terconazole 80mg vaginal suppository: Insert one suppository daily for 3 days 1
• Tioconazole 6.5% ointment: Apply 5g intravaginally as a single application 1

Oral Treatment

• Fluconazole 150mg: Take as a single oral dose 1, 3

Treatment Selection Guidelines

For Uncomplicated Vulvovaginal Candidiasis

• Single-dose treatments are appropriate for mild-to-moderate cases 1
• Multi-day regimens (3-7 days) are preferred for severe or complicated infections 1
• Many topical preparations (butoconazole, clotrimazole, miconazole, tioconazole) are available over-the-counter 1, 2

For Complicated Cases

• Recurrent vulvovaginal candidiasis (RVVC) may require longer treatment courses 4
• Non-albicans Candida species may be less susceptible to fluconazole and require alternative treatments 4, 5

Important Considerations

Diagnosis

• Diagnosis should be confirmed by symptoms (pruritus, vaginal discharge, soreness) plus either:
  • Wet preparation/Gram stain showing yeasts/pseudohyphae, or
  • Positive culture for yeast species 1
• Normal vaginal pH (≤4.5) is typical with Candida infections 1
• 10-20% of women normally harbor Candida without symptoms, so identification of Candida without symptoms does not require treatment 1

Self-Treatment

• Self-medication with OTC preparations is appropriate only for women with previously diagnosed VVC experiencing recurrence of the same symptoms 1
• Women whose symptoms persist after using OTC preparations or who experience recurrence within 2 months should seek medical care 1

Special Populations

• Pregnant women can be treated with topical azoles 1
• HIV-positive patients should receive the same treatment as HIV-negative patients 1

Efficacy Comparison

• Topically applied azole drugs are more effective than nystatin 1
• Treatment with azoles results in relief of symptoms and negative cultures in 80-90% of patients who complete therapy 1
• While terbinafine has been studied for vulvovaginal candidiasis, it showed lower mycologic cure rates (33.3%) compared to fluconazole (66.6%) and is not recommended as first-line treatment 6

Common Pitfalls to Avoid

• Treating without confirming diagnosis can lead to inappropriate therapy 1
• Failing to complete the full course of treatment may result in recurrence 1
• Ignoring persistent symptoms after treatment may allow progression of infection 1
• Not considering non-albicans Candida species in treatment failures 4, 5
• Concurrent bacterial vaginosis may be present and should be considered in cases that don't respond to antifungal therapy alone 7