From the Guidelines
Vaginal candidiasis can be effectively treated with antifungal medications, and for uncomplicated cases, I recommend using over-the-counter topical azoles such as clotrimazole 1% cream applied intravaginally for 7 days, miconazole 2% cream for 7 days, or a single dose of fluconazole 150 mg taken orally, as supported by the most recent guidelines 1.
Treatment Options
- Uncomplicated vaginal candidiasis:
- Clotrimazole 1% cream applied intravaginally for 7 days
- Miconazole 2% cream applied intravaginally for 7 days
- Single dose of fluconazole 150 mg taken orally
- Severe or recurrent infections:
- Longer treatment courses may be necessary, such as fluconazole 150 mg taken every 72 hours for 3 doses, or 7-14 days of topical therapy
Important Considerations
- During treatment, avoid douching, scented hygiene products, and tight-fitting clothing that can exacerbate symptoms
- Maintain good hygiene by keeping the genital area clean and dry
- Symptoms typically include vaginal itching, burning, abnormal discharge resembling cottage cheese, and discomfort during urination or intercourse
- Candida albicans overgrowth occurs when the vaginal environment's balance is disrupted, often due to antibiotics, hormonal changes, diabetes, or immunosuppression
Recurrent Infections
- Defined as ≥4 episodes of symptomatic infection within one year
- Usually caused by azole-susceptible C. albicans
- Treatment should begin with induction therapy with a topical agent or oral fluconazole for 10–14 days, followed by a maintenance azole regimen for at least 6 months, as recommended by the Infectious Diseases Society of America 1
Consultation
If symptoms persist after treatment, recur frequently, or if you're pregnant, consult a healthcare provider for proper evaluation and management, as advised by the Centers for Disease Control and Prevention 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
The therapeutic cure rate for vaginal candidiasis with fluconazole is 55%.
- Clinical cure was achieved in 69% of patients.
- Mycologic eradication was achieved in 61% of patients. This data is based on studies using a 150 mg fluconazole tablet administered orally 2.
From the Research
Definition and Prevalence of Vaginal Candidiasis
- Vaginal candidiasis, also known as vulvovaginal candidiasis, is a common fungal infection affecting women, with recurrent vulvovaginal candidiasis (RVVC) occurring in up to 10% of women 3.
- RVVC is defined as three or more confirmed infections over 1 year, with the objective often being symptomatic control rather than mycologic cure.
Treatment Options for Vaginal Candidiasis
- Current treatment options include oral fluconazole, which is recommended as first-line maintenance by the Centers for Disease Control and Prevention (CDC) 3.
- Topical treatments, such as clotrimazole, miconazole, terconazole, and intravaginal boric acid, can be considered if oral fluconazole is not feasible 3.
- A single oral dose of fluconazole (150 mg) has been shown to be effective in treating vaginal candidiasis, with a clinical response rate of 97% and a mycologic cure rate of 93% 4.
- Comparative studies have found that oral fluconazole is more effective than intravaginal clotrimazole in the long term, with a significant advantage in terms of symptom relief and mycologic cure 5.
Recurrent Vulvovaginal Candidiasis (RVVC) Treatment
- A combined systemic (fluconazole) and topical (metronidazole + clotrimazole) therapy has been proposed as a new approach to the treatment and prophylaxis of RVVC 6.
- This approach aims to address the recurrent infection aggressively from the outset, attempting to treat acute symptoms and prevent new events by countering potential risk factors of recurrence.
- The treatment scheme involves fluconazole 200 mg on specific days, metronidazole/clotrimazole ovules, and probiotic therapy, with the goal of restoring the vaginal lactobacillus species and preventing recurrence 6.
Safety and Efficacy of Treatment Options
- Oral fluconazole has been shown to be safe and well-tolerated, with a low incidence of side effects and abnormal laboratory test results 4.
- Topical treatments, such as clotrimazole and miconazole, have also been found to be effective and safe, with a low rate of side effects 5.
- The choice of treatment should be based on the individual patient's needs and medical history, with consideration of factors such as pregnancy and prior response to treatment 3, 7.