From the Guidelines
Yeast infection creams, such as clotrimazole 1% cream, are effective treatments for vaginal yeast infections and should be applied intravaginally for 7-14 days, as recommended by the 2021 Centers for Disease Control and Prevention guidelines 1.
Treatment Options
The treatment options for yeast infections include:
- Over-the-counter intravaginal agents, such as clotrimazole 1% cream, clotrimazole 2% cream, miconazole 2% cream, miconazole 4% cream, and tioconazole 6.5% ointment
- Prescription intravaginal agents, such as butoconazole 2% cream, terconazole 0.4% cream, and terconazole 0.8% cream
- Oral agents, such as fluconazole 150 mg single dose ### Diagnosis Diagnosis of vulvovaginal candidiasis can be made clinically, but it is essential to confirm the diagnosis with a wet-mount preparation or vaginal culture to rule out other conditions.
Application and Duration
The cream should be applied directly into the vagina using the provided applicator, typically once daily before bedtime, and the full treatment course should be completed even if symptoms improve quickly.
Common Symptoms
Common symptoms that indicate a yeast infection include vaginal itching, burning, redness, and thick white discharge resembling cottage cheese. If this is your first suspected yeast infection, symptoms persist after treatment, or you experience frequent recurrences, consult a healthcare provider as these could indicate a different condition or a need for prescription-strength medication. According to the 2021 Centers for Disease Control and Prevention guidelines, the recommended regimens for treatment of vulvovaginal candidiasis are outlined in Table 1, which includes various over-the-counter and prescription options 1. In a study published in Clinical Infectious Diseases, the performance characteristics of molecular testing for vulvovaginal candidiasis were found to have high clinical accuracy, with sensitivity and specificity of 90.9% and 94.1%, respectively 1. Another study published in the same journal found that oral and topical antifungal formulations have been shown to achieve entirely equivalent results, and that uncomplicated infection can be effectively treated with either single-dose fluconazole or short-course fluconazole for 3 days 2.
From the FDA Drug Label
indications and usage Terconazole Vaginal Cream is indicated for the local treatment of vulvovaginal candidiasis (moniliasis). As this product is effective only for vulvovaginitis caused by the genus Candida, the diagnosis should be confirmed by KOH smears and/or cultures.
Terconazole Vaginal Cream is used to treat yeast infections, specifically vulvovaginal candidiasis (moniliasis), caused by the genus Candida 3.
- The diagnosis of yeast infection should be confirmed by KOH smears and/or cultures before using the cream.
- Terconazole Vaginal Cream is effective for treating yeast infections in the vulvovaginal area.
From the Research
Yeast Infection Creams
- Yeast infection creams are used to treat vulvovaginal candidiasis, a common fungal infection affecting women 4.
- The Centers for Disease Control and Prevention (CDC) recommend oral fluconazole as the first-line treatment, but topical creams can be used as an alternative or in addition to oral medication 4.
Types of Yeast Infection Creams
- Clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested recommendations for recurrent vulvovaginitis caused by both Candida albicans and nonalbicans species 4.
- Nystatin ovules may not be as effective as azoles, and identification of the species will influence treatment decisions 4.
- Fluconazole and clotrimazole have been compared in the treatment of oral candidiasis, with fluconazole showing a slightly better clinical cure rate 5.
Treatment Regimens
- A combined systemic (fluconazole) and topical (metronidazole + clotrimazole) therapy has been proposed as a new approach to the treatment and prophylaxis of recurrent candidiasis 6.
- The treatment regimen includes fluconazole 200 mg on day 1, 4, 11, 26, then 1 dose/month for 3 months, plus metronidazole/clotrimazole ovules 1/day for 6 days the first week, then 1 ovule/day for 3 days the week before the menstrual cycle for 3 months 6.