What is the treatment for vulvovaginal candidiasis (VVC)?

From the Guidelines

For the treatment of uncomplicated vaginal yeast infections, a single 150-mg oral dose of fluconazole is recommended, as it is a highly effective and convenient option. This recommendation is based on the most recent and highest quality study available, which was published in 2022 1. The study provides a comprehensive review of the evidence for the treatment of vulvovaginal candidiasis and recommends fluconazole as a first-line treatment option.

Treatment Options

• Over-the-counter intravaginal agents, such as clotrimazole, miconazole, and tioconazole, are also effective for treating uncomplicated vaginal yeast infections 1
• Prescription intravaginal agents, such as butoconazole and terconazole, may be used for more severe or recurrent infections 1
• It is essential to note that the creams and suppositories used for treatment are oil-based and may weaken latex condoms and diaphragms 1

Administration and Precautions

• For application, insert the medication deep into the vagina at bedtime using the provided applicator, and continue treatment for the full recommended duration even if symptoms improve
• During treatment, avoid douching, use unscented products, wear cotton underwear, and avoid tight clothing
• Pregnant women should always consult a doctor before using any antifungal medication

Follow-up and Recurrence

• If symptoms persist after treatment, recur frequently, or are accompanied by fever or severe pain, consult a healthcare provider as you may need a longer course of treatment or have a different condition
• Women who have been diagnosed previously with vaginal yeast infections and experience a recurrence of the same symptoms can use over-the-counter preparations, but should seek medical care if symptoms persist or recur within 2 months 1

From the FDA Drug Label

Vaginal candidiasis: Two adequate and well-controlled studies were conducted in the U. S. using the 150 mg tablet. In both, the results of the fluconazole regimen were comparable to the control regimen (clotrimazole or miconazole intravaginally for 7 days) both clinically and statistically at the one month post-treatment evaluation The therapeutic cure rate, defined as a complete resolution of signs and symptoms of vaginal candidiasis (clinical cure), along with a negative KOH examination and negative culture for Candida (microbiologic eradication), was 55% in both the fluconazole group and the vaginal products group

Treatment of vaginal yeast infections can be achieved with:

• Fluconazole (PO): a single 150 mg tablet, with a therapeutic cure rate of 55% 2
• Clotrimazole (PV): intravaginally for 7 days, with a therapeutic cure rate comparable to fluconazole 2 and 3 Key points:
• Fluconazole and clotrimazole have comparable therapeutic cure rates for vaginal candidiasis
• Fluconazole is administered orally as a single 150 mg tablet, while clotrimazole is administered intravaginally for 7 days

From the Research

Treatment Options for Vaginal Yeast Infections

• Local treatment is often the first line of choice for acute vaginal yeast infections, with a success rate of 84-90% 4
• Systemic antimicrobial drug therapy with oral fluconazole can be used in combination with topical treatments for recurrent vulvovaginal candidiasis (RVVC) 5
• Different antifungal medications, such as clotrimazole, fluconazole, and itraconazole, can be used to treat vaginal candidiasis, with varying degrees of effectiveness 6, 7, 8

Comparison of Treatment Regimens

• A study comparing oral fluconazole with intra-vaginal clotrimazole found that fluconazole was more effective in treating acute vulvovaginal candidiasis 7
• Another study found that clotrimazole vaginal tablet was as effective as oral fluconazole in treating severe vulvovaginal candidiasis 8
• A review of the literature suggested that a combined treatment approach using both systemic and topical antifungal medications, along with probiotic therapy, may be effective in preventing recurrence of RVVC 5

Considerations for Treatment

• The choice of treatment may depend on the severity of the infection, as well as the presence of any underlying medical conditions or other factors that may affect treatment outcomes 4, 8
• Treatment regimens may need to be tailored to individual patients, taking into account their specific needs and circumstances 5, 7