What is the treatment for vaginal thrush?

Treatment for Vaginal Thrush (Vulvovaginal Candidiasis)

The most effective treatments for vaginal thrush include both topical azole antifungals (such as clotrimazole, miconazole, or terconazole) applied intravaginally for 1-7 days or a single oral dose of fluconazole 150 mg, with both approaches showing 80-90% efficacy in resolving symptoms and eliminating the infection. 1

Diagnosis

• Typical symptoms include vaginal itching, burning, soreness, dyspareunia, external dysuria, and white discharge 1
• Diagnosis is confirmed by:
  • Presence of symptoms plus
  • Wet preparation/Gram stain showing yeasts/pseudohyphae or
  • Positive culture for Candida species 1
• Normal vaginal pH (≤4.5) is typically present with candida infections 1

First-Line Treatment Options

Topical Intravaginal Treatments:

• Clotrimazole options:

  • 1% cream: 5g intravaginally for 7-14 days 1
  • 100 mg vaginal tablet: daily for 7 days 1
  • 100 mg vaginal tablet: two tablets for 3 days 1
  • 500 mg vaginal tablet: single application 1

• Miconazole options:

  • 2% cream: 5g intravaginally for 7 days 1
  • 100 mg vaginal suppository: daily for 7 days 1
  • 200 mg vaginal suppository: daily for 3 days 1

• Other effective topical options:

  • Butoconazole 2% cream: 5g intravaginally for 3 days 1
  • Tioconazole 6.5% ointment: 5g intravaginally as single application 1
  • Terconazole 0.4% cream: 5g intravaginally for 7 days 1
  • Terconazole 0.8% cream: 5g intravaginally for 3 days 1
  • Terconazole 80 mg vaginal suppository: daily for 3 days 1

Oral Treatment:

• Fluconazole 150 mg oral tablet: single dose 1, 2
  • Equally effective as topical treatments with 55% therapeutic cure rate 2
  • More convenient single-dose administration 2
  • May cause more gastrointestinal side effects than topical treatments 2

Treatment Selection Considerations

• Single-dose treatments are appropriate for mild to moderate cases 1
• Multi-day regimens (3-7 days) are preferred for severe cases 1
• Topical treatments have fewer systemic side effects 1
• Oral fluconazole offers convenience of single-dose treatment 2
• Oil-based creams and suppositories may weaken latex condoms and diaphragms 1

Special Populations

Children:

• For children under 12 years: consult a doctor 3
• For children 12 years and older: same adult dosing applies 3

Pregnancy:

• Clotrimazole is safe during pregnancy, including first trimester 4
• Vaginal clotrimazole treatment in first trimester may reduce preterm births 4

Follow-Up

• Return for follow-up only if symptoms persist after completing treatment or recur within 2 months 1, 5
• If symptoms persist beyond 7 days of treatment, reassessment is recommended 5

Management of Recurrent Vulvovaginal Candidiasis

• For women with ≥4 episodes per year, longer maintenance therapy may be needed 6, 7
• Weekly fluconazole 150 mg for 6 months has shown 90.8% disease-free rate at 6 months 6
• After stopping maintenance therapy, recurrence rates increase significantly 6

Partner Management

• VVC is not usually sexually transmitted; treatment of partners is not routinely recommended 1
• Partners with symptoms (e.g., balanitis) may benefit from topical antifungal treatment 1

Common Pitfalls

• Self-medication with OTC preparations should only be advised for women previously diagnosed with VVC who experience the same symptoms 1
• Unnecessary or inappropriate use of OTC preparations can delay proper diagnosis and treatment 1
• Non-albicans Candida species (especially C. glabrata) may be resistant to standard treatments and require alternative approaches 4, 8
• Always consider other causes if treatment fails, such as bacterial vaginosis, trichomoniasis, or non-infectious conditions 8