From the Guidelines
Yeast infections typically present with symptoms such as pruritus, irritation, vaginal soreness, external dysuria, and dyspareunia, often accompanied by a change in vaginal discharge, and can be diagnosed clinically when these symptoms are accompanied by signs like vulvar edema, erythema, excoriation, fissures, and a white, thick, curd-like vaginal discharge 1. The diagnosis of a yeast infection can usually be made clinically, but it should be confirmed by a wet mount preparation with use of saline and 10% potassium hydroxide to demonstrate the presence of yeast or hyphae, and vaginal cultures for Candida should be obtained for those with negative wet mount findings 1. Some key signs and symptoms of yeast infections include:
- Intense vaginal itching
- Burning during urination or sex
- Redness and swelling of the vulva
- A thick, white, odorless discharge resembling cottage cheese
- Vulvar edema, erythema, excoriation, fissures It is essential to note that these symptoms and signs are nonspecific and can be the result of a variety of infectious and noninfectious etiologies, and therefore, diagnosis should be confirmed before proceeding with empirical antifungal therapy 1. The treatment for yeast infections can vary depending on the severity and frequency of the infection, but uncomplicated vaginal yeast infections can be effectively treated with either single-dose or short-course therapy, both of which achieve >90% response 1. Some treatment options for yeast infections include:
- Over-the-counter antifungal medications like miconazole or clotrimazole as creams or suppositories for 1-7 days
- Prescription oral fluconazole as a single 150mg dose
- Topical therapy administered intravaginally daily for ~7 days or multiple doses of fluconazole (150 mg every 72 h for 3 doses) for complicated vaginal yeast infections 1.
From the FDA Drug Label
If you get a vaginal yeast infection, you may have any of the following symptoms: itching a burning feeling when you urinate redness soreness a thick white vaginal discharge that looks like cottage cheese The signs and symptoms of a yeast infection include:
- Itching
- A burning feeling when urinating
- Redness
- Soreness
- A thick white vaginal discharge that looks like cottage cheese 2
From the Research
Yeast Infection Signs and Symptoms
- The signs and symptoms of yeast infection can be relieved more rapidly with fluconazole treatment, as shown in a study published in the British journal of obstetrics and gynaecology 3.
- Clinical and mycological evidence of vaginal candidiasis can be treated effectively with fluconazole, with a favourable clinical response obtained in 99% of patients at short-term assessment and 93% at long-term assessment 3.
- Recurrent vulvovaginal candidiasis (RVVC) can be treated with a combined scheme using systemic antimicrobial drug therapy with oral fluconazole and topical drug therapy using metronidazole and clotrimazole, as proposed in a review published in Minerva ginecologica 4.
- Severe vulvovaginal candidiasis can be treated effectively with clotrimazole vaginal tablet or oral fluconazole, with clinical cure rates of 88.7% and 89.1% respectively at days 7-14 follow-up, as shown in a study published in Mycoses 5.
- Acute vulvovaginal candidiasis can be treated with a single dose of oral fluconazole 150 mg, which seems to be a valid and promising therapy to cure acute signs and symptoms, as shown in a study published in the Journal of infection and public health 6.
- A comparative study of fluconazole and clotrimazole for the treatment of vulvovaginal candidiasis found that a single oral dose of 150 mg fluconazole was as effective as a 100-mg clotrimazole vaginal suppository twice a day for 3 days, as published in Sexually transmitted diseases 7.
Treatment Options
- Fluconazole treatment can be given as a single oral dose of 150 mg, which can relieve symptoms more rapidly and is as safe as treatment with intravaginal clotrimazole 3.
- Clotrimazole vaginal tablet can be used as an alternative treatment for severe vulvovaginal candidiasis, with clinical cure rates similar to those of oral fluconazole 5.
- A combined scheme using systemic antimicrobial drug therapy with oral fluconazole and topical drug therapy using metronidazole and clotrimazole can be used to treat recurrent vulvovaginal candidiasis 4.
Efficacy and Safety
- Fluconazole treatment has been shown to be effective in treating vaginal candidiasis, with a mycological cure rate of 72% at long-term assessment 3.
- Clotrimazole treatment has been shown to be effective in treating severe vulvovaginal candidiasis, with clinical cure rates of 88.7% at days 7-14 follow-up 5.
- The safety of fluconazole and clotrimazole treatments has been established, with minimal side effects reported in several studies 3, 5, 7.