Medications for Vaginal Yeast Infection
First-Line Treatment Recommendation
For uncomplicated vaginal yeast infections, use either a single oral dose of fluconazole 150 mg OR short-course (1-3 day) topical azole therapy—both are equally effective with 80-90% cure rates. 1
Treatment Algorithm by Clinical Scenario
Uncomplicated Vulvovaginal Candidiasis
For mild-to-moderate, sporadic, nonrecurrent disease in otherwise healthy women:
Oral Option (Most Convenient):
- Fluconazole 150 mg as a single oral dose 2, 1, 3
- This is the preferred option for ease of administration 3
Topical Options (Equally Effective):
- Clotrimazole 500 mg vaginal tablet as a single dose 2, 4
- Miconazole 200 mg vaginal suppository once daily for 3 days 2
- Butoconazole 2% cream 5g intravaginally for 3 days 2
- Terconazole 0.8% cream 5g intravaginally for 3 days 2
All short-course azole regimens (1-3 days) achieve similar efficacy for uncomplicated cases 1. Single-dose clotrimazole 500 mg is as effective as multiple lower doses and comparable to oral azoles 4.
Complicated Vulvovaginal Candidiasis
For severe symptoms, recurrent infections (≥4 episodes/year), immunocompromised patients, uncontrolled diabetes, or suspected non-albicans Candida:
Requires longer duration therapy (10-14 days): 2, 1
- Clotrimazole 1% cream 5g intravaginally for 7-14 days 2
- Miconazole 2% cream 5g intravaginally for 7 days 2
- Terconazole 0.4% cream 5g intravaginally for 7 days 2
For recurrent VVC maintenance (after initial 7-14 day treatment): 2, 1
- Fluconazole 100-150 mg once weekly for 6 months 2
- Clotrimazole 500 mg vaginal suppository once weekly for 6 months 2
Pregnancy
Only topical azole therapies should be used during pregnancy—avoid oral fluconazole 1. Prolonged treatment regimens are effective in symptomatic pregnant women 4.
Over-the-Counter (OTC) Considerations
Several topical preparations are available OTC (butoconazole, clotrimazole, miconazole, tioconazole) 2, 5. However, self-medication should only be recommended for women previously diagnosed with VVC who experience recurrence of identical symptoms 2, 1. Any woman whose symptoms persist after OTC use or recur within 2 months must seek medical evaluation 2, 1.
Important Caveats
Oil-based creams and suppositories may weaken latex condoms and diaphragms 2, 1—counsel patients accordingly.
Nystatin is less effective than azoles 2, 1 and requires 14 days of treatment, making it a suboptimal choice.
Topical azoles are more effective than nystatin 2, with treatment success rates of 80-90% 2, 1.
Asymptomatic colonization (present in 10-20% of women) does not require treatment 2, 1—only treat symptomatic infections.
When to Follow Up
Patients only need follow-up if symptoms persist or recur within 2 months 2, 1. Routine follow-up for successful treatment is unnecessary.
Partner Treatment
Treatment of sex partners is not routinely recommended 2, 1, as VVC is not typically sexually transmitted. Consider partner treatment only in women with recurrent infections 2. Male partners with symptomatic balanitis (erythema, pruritus on glans) benefit from topical antifungal treatment 2, 1.
Special Populations
Women using birth control pills, antibiotics, pregnant women, and diabetics have increased risk of yeast infections 3. For diabetics with recurrent infections, ensure glucose control is optimized while using the longer 10-14 day treatment regimens 2.