What are the symptoms and treatment options for a yeast infection?

Yeast Infection Symptoms and Treatment

Vulvovaginal candidiasis (VVC) is characterized by vaginal itching, abnormal discharge, soreness, swelling, dyspareunia, and dysuria, and is most effectively treated with azole antifungals either topically or orally. 1

Symptoms of Yeast Infection

• Common symptoms include:

  • Vaginal itching (the most specific symptom for VVC) 1
  • Abnormal vaginal discharge (often white and curd-like) 1
  • Vaginal soreness and swelling 1
  • Vulvar burning 1, 2
  • Pain during sexual intercourse (dyspareunia) 1, 3
  • External dysuria (painful urination) 1
  • Redness of the vulva and vagina 4

• Diagnostic findings:

  • Normal vaginal pH (≤4.5) 1
  • Presence of yeast or pseudohyphae on microscopic examination 1
  • Positive yeast culture 1, 4

Treatment Options

For Uncomplicated VVC (90% of cases)

• Topical treatments:

  • Clotrimazole 1% cream 5g intravaginally for 7-14 days 1, 5
  • Clotrimazole 100mg vaginal tablet for 7 days 1
  • Miconazole 2% cream 5g intravaginally for 7 days 1
  • Butoconazole 2% cream 5g intravaginally for 3 days 1
  • Terconazole 0.4% cream 5g intravaginally for 7 days 1

• Oral treatment:

  • Fluconazole 150mg as a single oral dose 1, 6
  • Both topical and oral treatments achieve >90% response rates 1, 7

For Complicated VVC (10% of cases)

• Severe infection:

  • Fluconazole 150mg every 72 hours for 2-3 doses 1, 7
  • Longer duration (7-14 days) of topical therapy 7

• Recurrent VVC (4+ episodes per year):

  • Initial induction therapy with topical agent or oral fluconazole for 10-14 days 1, 7
  • Followed by maintenance therapy with fluconazole 150mg weekly for 6 months 1, 7

• Non-albicans Candida infection:

  • For C. glabrata: Boric acid 600mg in gelatin capsule vaginally daily for 14 days 1, 7
  • Alternative for C. glabrata: Nystatin intravaginal suppositories 100,000 units daily for 14 days 1
  • Third option: Topical 17% flucytosine cream alone or with 3% AmB cream for 14 days 1, 7

Special Populations

• Pregnant women:

  • Only 7-day topical azole therapies are recommended 1, 8
  • Oral fluconazole should be avoided due to potential risks of spontaneous abortion and birth defects 1

• HIV-positive women:

  • Treatment should not differ from HIV-negative women 1, 7
  • Lower CD4+ T-cell counts are associated with increased rates of VVC 1

Important Considerations

• Diagnosis confirmation:

  • Wet-mount preparation with saline and 10% potassium hydroxide to demonstrate yeast or hyphae 1, 7
  • Vaginal cultures for those with negative microscopy findings 7
  • Do not treat asymptomatic colonization (10-20% of women normally harbor Candida) 1, 8

• Partner management:

  • VVC is not typically sexually transmitted; treatment of sex partners is not routinely recommended 8

• Self-treatment:

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

• Follow-up:

  • Follow-up is unnecessary for women who become asymptomatic after treatment 1
  • Return visits only needed if symptoms persist or recur 1

• Antifungal resistance:

  • Increasing incidence of non-albicans Candida infections may require species identification and susceptibility testing in recurrent cases 3, 9