Treatment of Vaginal Yeast Infections (Vulvovaginal Candidiasis)

Women with symptomatic vulvovaginal candidiasis (yeast infection) should receive treatment to relieve symptoms and eradicate the infection. 1, 2

Diagnosis

Vulvovaginal candidiasis (VVC) is characterized by pruritus, white discharge, vaginal soreness, vulvar burning, dyspareunia, and external dysuria 2, 1
Diagnosis is confirmed when a woman has symptoms of vaginitis plus either wet preparation or Gram stain showing yeasts/pseudohyphae, or positive culture for yeast species 2, 1
Using 10% KOH in wet preparations improves visualization of yeast and mycelia 2, 1
Yeast culture remains the gold standard for diagnosis, though microscopy and clinical assessment are commonly used 2

Fluconazole 150mg oral tablet: single dose 2, 4
A single oral dose of fluconazole is as effective as multi-day topical treatments, with cure rates of 80-90% 1, 4

Both topical azoles and oral fluconazole provide relief of symptoms and negative cultures in 80-90% of patients who complete therapy 2, 1
Single-dose treatments are appropriate for mild-to-moderate cases, while multi-day regimens (3-day and 7-day) are preferred for severe or complicated VVC 1
Oil-based creams and suppositories may weaken latex condoms and diaphragms 2, 3
Patients should be instructed to complete the full course of treatment even if symptoms improve 1

Topical azole antifungals are the recommended treatment during pregnancy for at least 7 days 2, 5
Oral metronidazole or clindamycin are recommended options for bacterial vaginosis during pregnancy 2
Pregnant women with symptomatic trichomoniasis should be treated with oral metronidazole 2

Patients with HIV should receive the same treatment as those without HIV 2, 1
Lower CD4+ T-cell counts are associated with increased rates of VVC, and VVC is associated with increased viral shedding 2

Complicated VVC (severe symptoms, recurrent infections, non-albicans species) requires longer treatment courses 2
For recurrent VVC (≥4 episodes/12 months), treatment should begin with induction therapy with a topical agent or oral fluconazole for 10-14 days, followed by maintenance therapy for at least 6 months 2
Fluconazole 150mg weekly is an effective maintenance regimen for recurrent VVC 2

Patients should return for follow-up only if symptoms persist after completing treatment or if symptoms recur within 2 months 2, 1
Any woman whose symptoms persist after using an OTC preparation or who experiences recurrence within 2 months should seek medical care 2, 1

Keep the genital area cool and dry as yeast grows well in warm, moist areas 3
Wear cotton underwear and loose-fitting clothes 3
Change out of damp clothes or wet bathing suits promptly 3
Avoid unnecessary antibiotic use, as antibiotics can disrupt normal vaginal flora 3, 6

VVC is not usually acquired through sexual intercourse; treatment of sex partners is not routinely recommended 2, 3
Consider treatment of male partners in women with recurrent infections 2, 7
If the male partner has symptoms (rash, itching, discomfort in genital area), he should seek medical evaluation 3