What medications are used to treat vaginal itching?

Medications for Vaginal Itching

For vaginal itching caused by vulvovaginal candidiasis (the most common cause), first-line treatment is either a single 150 mg oral dose of fluconazole or topical azole therapy for 7-14 days. 1, 2

First-Line Treatment Options

Oral Therapy

• Fluconazole 150 mg as a single oral dose is highly effective, achieving clinical cure or improvement in 92-99% of patients at short-term evaluation and 91% at long-term follow-up 1, 3
• This single-dose regimen provides rapid symptom relief and sustained therapeutic concentrations in vaginal secretions 3, 4
• Fluconazole is contraindicated if you take quinidine, erythromycin, or pimozide, and should be avoided during pregnancy 5

Topical Azole Therapy (Intravaginal)

• Clotrimazole 1% cream 5g intravaginally for 7-14 days 6, 7
• Clotrimazole 100 mg vaginal tablet daily for 7 days or 500 mg as single dose 2
• Miconazole 2% cream 5g intravaginally for 7 days 6
• Terconazole 0.4% cream 5g intravaginally for 7 days 6
• Terconazole 0.8% cream 5g intravaginally for 3 days 6
• Topical azoles demonstrate 80-90% relief of symptoms and negative cultures among patients who complete therapy 2
• Important caveat: Oil-based vaginal creams and suppositories may weaken latex condoms and diaphragms 6

Alternative Topical Therapy

• Nystatin 100,000-unit vaginal tablet daily for 14 days is an alternative when azoles cannot be used, though it is less effective than azole medications and requires longer treatment duration 2

Treatment Algorithm Based on Clinical Scenarios

Uncomplicated Vulvovaginal Candidiasis

• Use either single-dose oral fluconazole 150 mg OR topical azole for 7-14 days 1, 2
• Choose oral therapy for convenience and patient preference; choose topical for pregnancy or drug interactions 5

Complicated Vulvovaginal Candidiasis (Severe Symptoms)

• Extend treatment duration to 7-14 days with topical agents OR fluconazole 150 mg orally every 72 hours for 2-3 total doses 2

Recurrent Vulvovaginal Candidiasis (≥3 Episodes in 12 Months)

• Initial induction therapy: 7-14 days of topical azole or oral fluconazole 2
• Maintenance therapy: Fluconazole 150 mg weekly for 6 months 1, 2
• Patients with recurrent vaginitis are significantly less likely to respond to treatment (p < 0.001) 8

Non-Albicans Candida Species (e.g., C. glabrata)

• Use a non-fluconazole azole drug for 7-14 days as first-line therapy 2
• Consider nystatin vaginal suppositories as maintenance if non-albicans Candida continues to recur 2

Pregnancy

• Only topical azole therapies applied for 7 days are recommended 2
• Oral fluconazole must be avoided during pregnancy 2, 5
• If pregnancy is possible, use birth control during fluconazole treatment and for 1 week after the final dose 5

Important Clinical Considerations

When to Reassess

• Return for follow-up only if symptoms persist after completing treatment or recur within 2 months 9, 6
• If symptoms persist beyond 7 days of treatment, reassessment is recommended to consider alternative diagnoses 9

Common Pitfalls to Avoid

• Do not treat asymptomatic Candida colonization, as 10-20% of women normally harbor Candida species in the vagina 2
• Self-medication with over-the-counter preparations should only be advised for women previously diagnosed with vulvovaginal candidiasis who experience recurrence of the same symptoms 2
• Treatment of sexual partners is not routinely recommended but may be considered for women with recurrent infection 6
• Avoid prescribing extended durations (e.g., 4 weeks) that exceed standard recommendations even for complicated cases 6

Side Effects

• Fluconazole: Most common are headache (13%), nausea (7%), and abdominal pain (6%); most are mild to moderate 5
• Topical azoles: Generally well-tolerated with minimal systemic side effects 8, 10