What is the typical treatment for a vaginal yeast infection?

Treatment of Vaginal Yeast Infection

For uncomplicated vaginal yeast infections, either a single dose of oral fluconazole 150 mg or short-course topical azole therapy (1-3 days) achieves 80-90% cure rates and should be first-line treatment. 1, 2

Confirming the Diagnosis

Before initiating treatment, confirm the diagnosis with:

• Clinical presentation: pruritus, white discharge, vulvar erythema, vaginal soreness, dyspareunia, or external dysuria 1
• Vaginal pH <4.5 (normal pH distinguishes yeast from bacterial vaginosis) 1, 2
• Laboratory confirmation: wet mount with 10% KOH showing yeasts or pseudohyphae, OR positive culture 1, 2

Critical pitfall: Do not treat asymptomatic colonization—10-20% of women harbor Candida without symptoms and do not require treatment 1, 3

First-Line Treatment Options for Uncomplicated VVC

Oral Therapy (Preferred for Convenience)

• Fluconazole 150 mg single oral dose 1, 2

Topical Therapy (Equally Effective)

Short-course regimens (1-3 days):

• Clotrimazole 500 mg vaginal tablet, single application 1, 2
• Miconazole 200 mg vaginal suppository daily for 3 days 1, 2
• Terconazole 0.8% cream 5g intravaginally for 3 days 1, 2
• Tioconazole 6.5% ointment 5g intravaginally, single application 1, 2

Important warning: Oil-based creams and suppositories may weaken latex condoms and diaphragms 1, 2, 4

When to Use Extended 7-Day Therapy

Use 7-day topical azole regimens for complicated VVC, defined as: 1, 2

• Severe symptoms (extensive vulvar erythema, edema, excoriation)
• Pregnancy (oral fluconazole is contraindicated) 3
• Recurrent infections (≥3 episodes in 12 months) 1
• Non-albicans Candida species 1
• Immunocompromised patients (diabetes, HIV, corticosteroid use) 1

7-Day Regimens:

• Clotrimazole 1% cream 5g intravaginally for 7-14 days 1, 3
• Clotrimazole 100 mg vaginal tablet daily for 7 days 1, 3
• Miconazole 2% cream 5g intravaginally for 7 days 1, 3
• Miconazole 100 mg vaginal suppository daily for 7 days 1, 3
• Terconazole 0.4% cream 5g intravaginally for 7 days 1, 3

Special Population: Pregnancy

Only topical azoles for 7 days are recommended during pregnancy—oral fluconazole is contraindicated. 3 Seven-day regimens are more effective than shorter courses in pregnant women 3

Treatment of Recurrent VVC (≥3 Episodes in 12 Months)

Recurrent VVC affects approximately 9% of women and causes significant morbidity, including lost productivity estimated at $4.7 billion annually 1

Two-Phase Approach:

Induction Phase: 1, 2

• Topical azole OR oral fluconazole for 10-14 days

Maintenance Phase (at least 6 months): 1, 2

• Fluconazole 150 mg orally once weekly (first-line maintenance) 1, 2
• Alternative: Ketoconazole 100 mg daily OR itraconazole 100 mg every other day 1

Important caveat: Maintenance fluconazole improves quality of life in 96% of women, but >63% experience recurrence after stopping therapy 1

Resistant or Non-Albicans Infections

For C. glabrata or azole-resistant infections: 1, 2

• Boric acid 600 mg gelatin capsules intravaginally daily for 14 days 1, 2
• Alternative: Topical nystatin (though less effective than azoles for C. albicans) 1

Key consideration: C. glabrata shows significantly reduced azole susceptibility at vaginal pH 4, with terconazole showing >388-fold higher MIC at pH 4 versus pH 7 1

Partner Management

Do not treat sexual partners routinely—VVC is not sexually transmitted. 1, 2 Exception: Male partners with symptomatic balanitis may benefit from topical antifungal treatment 3, 2

Over-the-Counter Self-Treatment

OTC preparations (butoconazole, clotrimazole, miconazole, tioconazole) should only be used by women with previously diagnosed VVC who have recurrence of identical symptoms 1, 2 Women with persistent symptoms after OTC treatment or recurrence within 2 months must seek medical evaluation 1, 2

Follow-Up

Patients should return only if: 2

• Symptoms persist after treatment
• Symptoms recur within 2 months
• Multiple recurrences occur (≥3 in 6 months), requiring evaluation for diabetes, immunosuppression, or other predisposing factors 1

Prevention Strategies

To reduce recurrence risk: 4

• Wear cotton underwear and loose-fitting clothes
• Change out of wet bathing suits or damp clothes promptly
• Avoid douching (removes protective vaginal flora and medication)
• Do not use tampons during treatment (removes medication from vagina)
• Avoid unnecessary antibiotic use when possible