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

Symptoms and Treatment of Yeast Infections

Clinical Presentation

Vaginal yeast infections typically present with vulvovaginal itching and erythema, often accompanied by a thick white discharge resembling cottage cheese, along with vaginal soreness, irritation, burning on urination, and painful intercourse. 1

Key Symptoms to Identify

• Vaginal itching is the hallmark symptom of vulvovaginal candidiasis 1, 2
• Thick white vaginal discharge that looks like cottage cheese is characteristic 1, 3
• Vulvovaginal erythema (redness) in the vulvovaginal area 1
• Burning sensation during urination or intercourse 1, 2
• Vaginal soreness and irritation 2, 3
• Rash or redness on the skin outside the vagina (vulva) 1

Critical Red Flags (NOT Yeast Infection)

• Fever, chills, lower abdominal/back/shoulder pain, or foul-smelling discharge indicate a more serious condition such as pelvic inflammatory disease or sexually transmitted infection, NOT a yeast infection 1, 2
• These symptoms require immediate medical evaluation 2

Diagnostic Approach

Diagnosis is confirmed when clinical symptoms are present AND either wet preparation with 10% KOH or Gram stain demonstrates yeasts/pseudohyphae, or culture yields positive results for yeast species. 1

• Normal vaginal pH (<4.5) is associated with vulvovaginal candidiasis, distinguishing it from bacterial vaginosis 1, 4
• 10% KOH wet preparation improves visualization of yeast and mycelia by disrupting cellular material 1
• Culture is helpful for complicated cases to identify non-albicans Candida species 5, 6
• Do NOT treat asymptomatic colonization, as 10-20% of women normally harbor Candida without requiring treatment 1, 4

Treatment Algorithm

For Uncomplicated Cases (90% of patients)

First-line treatment is either a single 150 mg dose of oral fluconazole OR short-course topical azole therapy for 1-7 days, with cure rates of 80-90%. 1, 5

Oral Option:

• Fluconazole 150 mg as a single oral dose 1, 5, 3

Topical Options (Multiple Equivalent Choices):

• Clotrimazole 1% cream 5g intravaginally for 7-14 days 1, 4
• Miconazole 2% cream 5g intravaginally for 7 days 1, 4, 2
• Terconazole 0.8% cream 5g intravaginally for 3 days 1, 5
• Single-dose options: Clotrimazole 500mg vaginal tablet OR Tioconazole 6.5% ointment 5g 1, 5

For Complicated Cases (10% of patients)

Complicated cases require extended therapy with topical azole for 7-14 days OR fluconazole 150 mg every 72 hours for 3 doses. 5

Complicated cases are characterized by: 5

• Severe symptoms
• Recurrent episodes (≥4 per year)
• Immunocompromised status
• Diabetes
• Pregnancy
• Non-albicans Candida species

Special Populations

Pregnancy:

• ONLY topical azoles are recommended during pregnancy; oral fluconazole is contraindicated 4
• 7-day regimens are more effective than shorter courses in pregnancy 4
• Recommended options: Clotrimazole 1% cream for 7-14 days, Miconazole 2% cream for 7 days, or Terconazole 0.4% cream for 7 days 4

Non-albicans Species (particularly C. glabrata):

• May not respond to standard azole therapy 5
• Boric acid 600 mg vaginal capsules for 14 days is recommended with 70-80% cure rate 5

Important Clinical Considerations

Critical Warnings

• Oil-based topical preparations may weaken latex condoms and diaphragms, requiring alternative contraception 1, 5, 2
• Do not use tampons during treatment, as they remove medication from the vagina; use deodorant-free sanitary pads instead 2
• Avoid douches, spermicides, and sexual intercourse during treatment 2
• Complete the full treatment course even if symptoms improve early to prevent treatment failure 7

Partner Management

• Vulvovaginal candidiasis is NOT sexually transmitted; routine partner treatment is not recommended 1, 4, 2
• Partners with symptomatic balanitis (erythema, pruritus on glans penis) may benefit from topical antifungal treatment 1

When to Seek Medical Evaluation

• First-time symptoms require medical diagnosis before self-treatment 1, 2
• Symptoms persist after treatment or recur within 2 months 1, 7, 5
• Recurrent infections (≥3 in 6 months or ≥4 per year) require evaluation for underlying conditions like diabetes, HIV, or immunosuppression 2
• Development of fever, chills, abdominal pain, or foul-smelling discharge suggests alternative diagnosis requiring immediate evaluation 5, 2

Common Pitfalls to Avoid

• Self-diagnosis is unreliable and leads to overuse of antifungals and potential contact dermatitis 5
• Unnecessary use of OTC preparations can delay treatment of other causes of vulvovaginitis (bacterial vaginosis, trichomoniasis, STDs) with adverse clinical outcomes 1
• Mixed infections are common: vulvovaginal candidiasis can occur concomitantly with bacterial vaginosis or STDs, requiring treatment of all pathogens present 1, 8
• Premature discontinuation of therapy leads to treatment failure 7

Prevention Strategies

• Keep the genital area cool and dry: wear cotton underwear, loose-fitting clothes, and change out of wet bathing suits promptly 2
• Avoid tight layers or moist clothing in the genital area 2
• Change minipads frequently if used between periods 2
• Discuss medication risks with your physician: antibiotics, steroids, and birth control pills increase yeast infection risk 2