What is the treatment for genital yeast overgrowth?

Treatment of Genital Yeast Overgrowth

For uncomplicated genital yeast infections, first-line treatment includes topical azole medications for 1-7 days or a single oral dose of fluconazole 150mg, with both approaches achieving >90% cure rates. 1, 2

First-Line Treatment Options

Topical Treatments

• Clotrimazole 1% cream applied to affected areas for 7-14 days 1, 3
• Miconazole 2% cream applied to affected areas for 7 days 3
• Butoconazole 2% cream for 3 days 3
• Clotrimazole vaginal tablets (100mg for 7 days or 500mg as single dose) 1

Oral Treatment

• Fluconazole 150mg oral tablet as a single dose 1, 2
• Clinical cure rates with oral fluconazole are comparable to topical treatments (69% vs 72%) 2
• Fluconazole offers the convenience of single-dose oral administration 2

Treatment Based on Severity

Mild to Moderate Infection

• Topical azole for 1-7 days OR fluconazole 150mg single oral dose 1, 3
• Both approaches achieve clinical cure rates of approximately 80% in acute cases 2

Severe Infection

• Longer duration of therapy (7-14 days) with topical agents 4, 3
• OR fluconazole 150mg orally every 72 hours for a total of 2-3 doses 4, 3

Special Situations

Recurrent Vulvovaginal Candidiasis (RVVC)

• Defined as ≥3 symptomatic episodes in 12 months 4
• Treatment approach:
  1. Initial induction therapy: 7-14 days of topical azole or oral fluconazole 4, 5
  2. Maintenance therapy: weekly fluconazole 150mg for 6 months 4, 6
  3. Weekly maintenance fluconazole reduces recurrence rates significantly (90.8% disease-free at 6 months vs 35.9% with placebo) 6

Non-albicans Candida Species

• Longer duration (7-14 days) with a non-fluconazole azole drug as first-line therapy 4, 5
• If recurrence occurs, boric acid 600mg in a gelatin capsule vaginally once daily for 2 weeks (70% eradication rate) 4, 5
• For persistent non-albicans VVC, consider nystatin 100,000 units vaginal suppositories daily as maintenance 4, 5

Pregnancy

• Only topical azole therapies applied for 7 days are recommended 4
• Oral fluconazole should be avoided during pregnancy 4

Alternative Treatments

Nystatin

• Nystatin 100,000-unit vaginal tablet daily for 14 days is considered an alternative when azoles cannot be used 1
• Less effective than azole medications, with azoles demonstrating superior efficacy (80-90% relief vs lower rates with nystatin) 1

Other Options for Resistant Cases

• Topical 17% flucytosine cream alone or with 3% AmB cream for 14 days (must be compounded) 5
• For azole-resistant C. albicans, topical boric acid (600mg daily for 14 days) 5

Common Pitfalls and Caveats

• Self-medication with over-the-counter preparations should only be used for women previously diagnosed with VVC who experience recurrence of the same symptoms 1
• Women whose symptoms persist after using OTC preparations or who experience symptom recurrence within 2 months should seek medical care 1
• Identifying Candida in the absence of symptoms should not lead to treatment, as 10-20% of women normally harbor Candida species in the vagina 1
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1
• After cessation of maintenance therapy for RVVC, a 40-50% recurrence rate can be anticipated 5, 6