Treatment of Yeast Infection During Pregnancy
Use topical azole antifungals for 7 days as the only recommended treatment for vulvovaginal candidiasis in pregnancy. 1, 2
First-Line Treatment Options
The CDC recommends the following intravaginal formulations, all applied for 7 days: 2
- Clotrimazole 1% cream 5g intravaginally daily 2
- Clotrimazole 100mg vaginal tablet daily 2
- Miconazole 2% cream 5g intravaginally daily 2
- Miconazole 100mg vaginal suppository daily 2
- Terconazole 0.4% cream 5g intravaginally daily 2
Why 7-Day Regimens Are Essential in Pregnancy
Pregnant women require longer treatment courses than non-pregnant women. 3 While non-pregnant women can use 1-3 day regimens successfully, pregnancy necessitates 7-day therapy for adequate cure rates. 4, 5 Studies demonstrate that 4-day treatment is significantly less effective than 7-day treatment in pregnancy (odds ratio 11.7). 3
Critical Contraindications
Oral fluconazole is NOT recommended during pregnancy. 1, 4 Only topical azole therapies should be used. 1 This is a firm guideline from the CDC that distinguishes pregnancy management from non-pregnancy treatment. 1
Diagnostic Confirmation Before Treatment
Confirm the diagnosis with: 2
- Clinical symptoms: pruritus, white discharge, vulvar erythema 2
- Laboratory testing: wet mount with 10% KOH showing yeasts or pseudohyphae, or positive culture 2
- Normal vaginal pH ≤4.5 2
Common Pitfalls to Avoid
Do not use nystatin as first-line therapy. 2 Topical azoles achieve 80-90% cure rates compared to significantly lower efficacy with nystatin. 2 Multiple studies confirm imidazole drugs are more effective than nystatin in pregnancy (odds ratio 0.21). 5, 3
Do not treat asymptomatic colonization. 2 Approximately 10-20% of women normally harbor Candida in the vagina without requiring treatment. 2, 4
Avoid shorter treatment courses. 5, 3 The 7-day duration is evidence-based for pregnancy, and shorter regimens lead to treatment failure. 3
Partner Management
Treatment of sexual partners is not recommended. 2 VVC is not typically sexually transmitted. 2 Partners with symptomatic balanitis may benefit from topical antifungal treatment, but routine partner treatment is unnecessary. 2
Follow-Up Recommendations
Patients should return only if symptoms persist or recur. 2 Persistent symptoms warrant evaluation for other conditions or resistant infection. 2
Safety Considerations
Oil-based vaginal creams and suppositories may weaken latex condoms and diaphragms. 4 Counsel patients about alternative contraceptive methods during treatment if needed.