What cream is used to treat vaginal yeast infections?

Topical Azole Creams for Vaginal Yeast Infections

For uncomplicated vaginal yeast infections, use intravaginal clotrimazole 1% cream (5g for 7-14 days), clotrimazole 2% cream (5g for 3 days), miconazole 2% cream (5g for 7 days), or other azole creams—all are highly effective with 80-90% cure rates and are available over-the-counter. 1

First-Line Topical Cream Options

The CDC recommends multiple intravaginal azole cream formulations, all with comparable efficacy 1:

Most Commonly Used Creams (Available OTC):

• Clotrimazole 1% cream: 5g intravaginally for 7-14 days 1, 2
• Miconazole 2% cream: 5g intravaginally for 7 days 1
• Butoconazole 2% cream: 5g intravaginally for 3 days 1
• Tioconazole 6.5% ointment: 5g intravaginally as a single application 1

Prescription-Only Creams:

• Terconazole 0.4% cream: 5g intravaginally for 7 days 1
• Terconazole 0.8% cream: 5g intravaginally for 3 days 1

Treatment Selection Algorithm

For uncomplicated cases (mild-to-moderate, first episode or sporadic, immunocompetent host):

• Short-course therapy (1-3 days) is equally effective as longer courses 1
• Single-dose or 3-day regimens provide convenience and improve compliance 3, 4
• Clotrimazole 500mg vaginal tablet (single dose) is as effective as multi-day lower-dose regimens 3

For complicated cases (severe symptoms, recurrent infections, diabetes, immunocompromised, or non-albicans species):

• Use longer duration therapy: 10-14 days of topical azoles 1
• Consider prescription-strength terconazole formulations 1

Evidence Quality and Effectiveness

Topical azole drugs are more effective than nystatin, achieving symptom relief and negative cultures in 80-90% of patients who complete therapy 1. Clotrimazole has over 45 years of clinical experience with consistently high cure rates and rare resistance 3. Comparative studies show clotrimazole 1% cream for 7 days has slightly better efficacy (75%) than miconazole 2% cream for 14 days (63%), with fewer adverse reactions 5. Three-day clotrimazole regimens (two 100mg tablets daily) are as effective as seven-day regimens (one tablet daily), with 85% vs 75% success rates respectively 4.

Critical Caveats

Important warnings 1:

• These oil-based creams and suppositories may weaken latex condoms and diaphragms
• Self-medication with OTC preparations should only occur in women previously diagnosed with VVC who have recurrent identical symptoms
• Any woman whose symptoms persist after OTC treatment or recur within 2 months must seek medical evaluation to avoid delayed diagnosis of other vulvovaginitis etiologies

Local side effects are minimal but may include burning or irritation in rare cases 1, 5. Systemic absorption is negligible with topical formulations 1.

When to Avoid Self-Treatment

Women should seek medical care rather than self-treating if 1:

• First episode of symptoms (diagnosis not yet confirmed)
• Symptoms persist after completing OTC therapy
• Symptoms recur within 2 months
• Pregnancy (requires medical supervision)
• Recurrent infections (≥4 episodes per year)