What is the best treatment for a typical yeast infection?

Treatment of Vaginal Yeast Infections

For uncomplicated vaginal yeast infections, use either topical azole antifungals (clotrimazole, miconazole, terconazole, or others) applied intravaginally for 1-7 days, or a single 150-mg oral dose of fluconazole—both approaches achieve 80-90% cure rates and are equally effective. 1

First-Line Treatment Options

Topical Intravaginal Azoles (Preferred for Most Cases)

Multiple formulations are available and equally effective 1:

Short-course regimens (1-3 days):

• Clotrimazole 500 mg vaginal tablet as a single dose 1
• Clotrimazole 200 mg vaginal suppository for 3 days 1
• Miconazole 1200 mg vaginal suppository as a single dose 1
• Tioconazole 6.5% ointment 5g as a single application 1
• Terconazole 0.8% cream 5g for 3 days 1

Standard regimens (7 days):

• Clotrimazole 1% cream 5g intravaginally for 7 days 1, 2
• Miconazole 2% cream 5g intravaginally for 7 days 1

Oral Therapy

• Fluconazole 150 mg as a single oral dose 1, 3

Key point: Topical azoles are more effective than nystatin 1. Many preparations (clotrimazole, miconazole, butoconazole, tioconazole) are available over-the-counter 1, 3, 2.

When to Modify Treatment

Severe Acute Infections

For severe symptoms, use fluconazole 150 mg every 72 hours for 2-3 total doses 1.

Non-albicans Species (Complicated Infections)

For C. glabrata (often fluconazole-resistant):

• First-line: Topical boric acid 600 mg intravaginally daily for 14 days 1
• Alternative: Nystatin 100,000-unit vaginal tablet daily for 14 days 1
• Third option: Topical 17% flucytosine cream alone or combined with 3% amphotericin B cream for 14 days 1

For C. krusei (inherently fluconazole-resistant):

• Use non-fluconazole azoles or amphotericin B-based therapy 1

Recurrent Vulvovaginal Candidiasis (≥4 episodes/year)

Treatment protocol 1:

1. Induction phase: 10-14 days of topical azole OR oral fluconazole
2. Maintenance phase: Fluconazole 150 mg weekly for 6 months 1

Alternative maintenance regimens include ketoconazole 100 mg daily, itraconazole 100 mg every other day, or daily topical azole 1.

Important Clinical Considerations

Diagnosis Confirmation

• Diagnosis requires both symptoms (pruritus, discharge, burning) AND either microscopy showing yeasts/pseudohyphae or positive culture 1
• Normal vaginal pH (≤4.5) supports the diagnosis 1
• 10-20% of asymptomatic women harbor Candida—do not treat colonization without symptoms 1

Common Pitfalls

• Self-diagnosis is unreliable: Women incorrectly self-diagnose yeast infections frequently, leading to overuse of antifungals and potential contact dermatitis 1
• When to seek medical care: If symptoms persist after OTC treatment or recur within 2 months 1
• Treatment duration matters: Single-dose regimens work well for uncomplicated mild-to-moderate infections, but severe or complicated cases require multi-day (3-7 day) regimens 1

Special Populations

• Pregnancy: Fluconazole can be used but discuss risks with provider; topical azoles are generally preferred 1, 3
• HIV-infected patients: Treat with same regimens as HIV-negative patients 1

Partner Management

Sexual partners generally do not require treatment as vulvovaginal candidiasis is not considered a sexually transmitted infection 1.