Treatment of Vaginal Yeast Infection in Pregnancy
Treat pregnant women with vaginal yeast infections using topical azole antifungals for 7 days—this is the only safe and effective approach during pregnancy, as oral antifungals are contraindicated due to teratogenic risks. 1, 2
First-Line Treatment Regimens
Use one of the following intravaginal topical azole options for 7 days 1, 2:
- Clotrimazole 1% cream 5g intravaginally for 7-14 days 1, 2
- Clotrimazole 100mg vaginal tablet daily for 7 days 1, 2
- Miconazole 2% cream 5g intravaginally for 7 days 1, 2
- Miconazole 100mg vaginal suppository daily for 7 days 1
- Terconazole 0.4% cream 5g intravaginally for 7 days 1
Seven-day regimens are more effective than shorter courses in pregnancy—this differs from non-pregnant women where 1-3 day treatments suffice. 1, 2, 3
Diagnostic Confirmation Before Treatment
Confirm the diagnosis by identifying 1, 2:
- Clinical symptoms: vulvar pruritus, white vaginal discharge, vulvar erythema, vaginal soreness, dyspareunia, or external dysuria 2
- Normal vaginal pH ≤4.5 (distinguishes from bacterial vaginosis or trichomoniasis) 1, 2
- Laboratory confirmation: wet mount with 10% KOH showing yeasts or pseudohyphae, OR positive culture for Candida species 1, 2
Critical Safety Considerations
Avoid all oral antifungal agents during pregnancy, particularly in the first trimester. 2, 4
- Fluconazole is associated with spontaneous abortion, craniofacial defects, and cardiac malformations when used systemically 2
- Oral azoles exhibit dose-dependent teratogenic effects 4
- Only topical azole therapies should be used throughout pregnancy 2
Treatment Efficacy
Topical azole treatments achieve 80-90% cure rates with symptom relief and negative cultures after therapy completion. 2 This is significantly superior to nystatin, which should be avoided as first-line therapy despite its safety profile. 1, 3
Management of Treatment Failure
If symptoms persist after completing the 7-day course 2:
- Consider non-albicans Candida species (may require alternative azole or longer treatment duration) 2
- Rule out alternative diagnoses (bacterial vaginosis, trichomoniasis, contact dermatitis) 2
- Extend treatment to 7-14 days for severe vulvovaginitis 2
Partner Management
Do not treat sexual partners routinely—vaginal candidiasis is not sexually transmitted and partner treatment does not prevent recurrence. 1, 2 The exception is partners with symptomatic balanitis, who may benefit from topical antifungal treatment. 1, 2
Special Considerations
Do not treat asymptomatic colonization—approximately 10-20% of women harbor Candida vaginally without symptoms, and this does not require treatment. 1, 2 Only symptomatic infections warrant therapy.
Follow-up is unnecessary if symptoms resolve, but patients should return if symptoms persist or recur to evaluate for resistant organisms or alternative diagnoses. 2