Which medications in the drug class Antifungals, Vaginal are used in the treatment of Vulvovaginitis?

Answer

Antifungals, Vaginal

These agents are used to treat vulvovaginal candidiasis. Topical azole antifungals achieve cure rates of 85-95%. Nystatin demonstrates a 75-80% cure rate. Oral fluconazole or ibrexafungerp have cure rate comparable to topical azole antifungals.^[55] These may be preferred by patients because of the ease of 1-time dosing.

Intravaginal and topical therapies with a variety of antifungals, such as clotrimazole, miconazole, terconazole, and tioconazole, are highly effective. Many of the preparations are now available OTC. 1-, 3-, and 7-day regimens can be used. Cure rates of 90% are reported with longer courses.

Butoconazole (Gynazole-1)

Butoconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.

Tioconazole (Vagistat-1, Monistat-1)

This is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.

Clotrimazole (Desenex, Gyne-Lotrimin 3, Clotrimazole 3 Day)

Clotrimazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.

Miconazole vaginal (Vagistat 3, Miconazole 7)

Miconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.

Terconazole (Terazol 3, Terazol 7, Zazole)

Terconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.

Ketoconazole topical (Xolegel 2%)

Ketoconazole is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.

Nystatin

Nystatin is a broad-spectrum antifungal agent that inhibits yeast growth by altering cell membrane permeability, causing fungal cell death.

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Chatwani AJ, Mehta R, Hassan S, Rahimi S, Jeronis S, Dandolu V. Rapid testing for vaginal yeast detection: a prospective study. Am J Obstet Gynecol. 2007 Apr. 196(4):309.e1-4. [Medline].
Donders G, Bellen G, Byttebier G, Verguts L, Hinoul P, Walckiers R, et al. Individualized decreasing-dose maintenance fluconazole regimen for recurrent vulvovaginal candidiasis (ReCiDiF trial). Am J Obstet Gynecol. 2008 Dec. 199(6):613.e1-9. [Medline].
Katz. Vaginitis. Katz. Comprehensive Gynecology. 5th ed. Mosby; Elsevier; 2007. 588-596.
Horowitz BJ, Edelstein SW, Lippman L. Sexual transmission of Candida. Obstet Gynecol. 1987 Jun. 69(6):883-6. [Medline].
Ip WK, Lau YL. Role of mannose-binding lectin in the innate defense against Candida albicans: enhancement of complement activation, but lack of opsonic function, in phagocytosis by human dendritic cells. J Infect Dis. 2004 Aug 1. 190(3):632-40. [Medline].
Lillegard JB, Sim RB, Thorkildson P, Gates MA, Kozel TR. Recognition of Candida albicans by mannan-binding lectin in vitro and in vivo. J Infect Dis. 2006 Jun 1. 193(11):1589-97. [Medline].
Liu F, Liao Q, Liu Z. Mannose-binding lectin and vulvovaginal candidiasis. Int J Gynaecol Obstet. 2006 Jan. 92(1):43-7. [Medline].
Giraldo PC, Babula O, Gonçalves AK, Linhares IM, Amaral RL, Ledger WJ, et al. Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis, and bacterial vaginosis. Obstet Gynecol. 2007 May. 109(5):1123-8. [Medline].
Fong IW. The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin Med. 1992 Jun. 68(3):174-6. [Medline]. [Full Text].
Pandit L, Ouslander JG. Postmenopausal vaginal atrophy and atrophic vaginitis. Am J Med Sci. 1997 Oct. 314(4):228-31. [Medline].
Pyka RE, Wilkinson EJ, Friedrich EG Jr, Croker BP. The histopathology of vulvar vestibulitis syndrome. Int J Gynecol Pathol. 1988. 7(3):249-57. [Medline].
Woodruff JD, Parmley TH. Infection of the minor vestibular gland. Obstet Gynecol. 1983 Nov. 62(5):609-12. [Medline].
Bergeron C, Moyal-Barracco M, Pelisse M, Lewin P. Vulvar vestibulitis. Lack of evidence for a human papillomavirus etiology. J Reprod Med. 1994 Dec. 39(12):936-8. [Medline].
Turner ML, Marinoff SC. Association of human papillomavirus with vulvodynia and the vulvar vestibulitis syndrome. J Reprod Med. 1988 Jun. 33(6):533-7. [Medline].
Marinoff SC, Turner ML. Vulvar vestibulitis syndrome. Dermatol Clin. 1992 Apr. 10(2):435-44. [Medline].
Westrom LV, Willen R. Vestibular nerve fiber proliferation in vulvar vestibulitis syndrome. Obstet Gynecol. 1998 Apr. 91(4):572-6. [Medline].
Szumigala JA, Alveredo R. Vulvovaginitis. Ferri. Ferri's Clinical Advisor 2009. Mosby; Elsevier; 2009. 155, 1008-1012.
Eckert LO. Clinical practice. Acute vulvovaginitis. N Engl J Med. 2006 Sep 21. 355(12):1244-52. [Medline].
Margesson LJ. Vulvar disease pearls. Dermatol Clin. 2006 Apr. 24(2):145-55, v. [Medline].
Foxman B, Muraglia R, Dietz JP, Sobel JD, Wagner J. Prevalence of recurrent vulvovaginal candidiasis in 5 European countries and the United States: results from an internet panel survey. J Low Genit Tract Dis. 2013 Jul. 17(3):340-5. [Medline].
Nyirjesy P. Vulvovaginal candidiasis and bacterial vaginosis. Infect Dis Clin North Am. 2008 Dec. 22(4):637-52, vi. [Medline].
Braverman PK. Urethritis, vulvovaginitis, and cervicitis. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Churchill Livingstone; Elsevier; 2008. 55.
Biggs WS, Williams RM. Common gynecologic infections. Prim Care. 2009 Mar. 36(1):33-51, viii. [Medline].
Johnson E, Berwald N. Evidence-based emergency medicine/rational clinical examination abstract. Diagnostic utility of physical examination, history, and laboratory evaluation in emergency department patients with vaginal complaints. Ann Emerg Med. 2008 Sep. 52(3):294-7. [Medline].
Nyirjesy P, Leigh RD, Mathew L, Lev-Sagie A, Culhane JF. Chronic vulvovaginitis in women older than 50 years: analysis of a prospective database. J Low Genit Tract Dis. 2012 Jan. 16(1):24-9. [Medline].
Halperin R, Zehavi S, Vaknin Z, Ben-Ami I, Pansky M, Schneider D. The major histopathologic characteristics in the vulvar vestibulitis syndrome. Gynecol Obstet Invest. 2005. 59(2):75-9. [Medline].
Esim Buyukbayrak E, Kars B, Karsidag AY, Karadeniz BI, Kaymaz O, Gencer S, et al. Diagnosis of vulvovaginitis: comparison of clinical and microbiological diagnosis. Arch Gynecol Obstet. 2010 Nov. 282(5):515-9. [Medline].
Schwiertz A, Taras D, Rusch K, Rusch V. Throwing the dice for the diagnosis of vaginal complaints?. Ann Clin Microbiol Antimicrob. 2006 Feb 17. 5:4. [Medline]. [Full Text].
[Guideline] Workowski KA, Berman S. Sexually Transmitted Diseases Treatment Guidelines, 2010. MMWR. Dec 17 2010;59(RR-12). Centers for Disease Control and Prevention. Available at https://www.cdc.gov/std/treatment/2010/default.htm. Accessed: August 22, 2013.
Ferris DG, Francis SL, Dickman ED, Miler-Miles K, Waller JL, McClendon N. Variability of vaginal pH determination by patients and clinicians. J Am Board Fam Med. 2006 Jul-Aug. 19(4):368-73. [Medline].
Kulp JL, Chaudhry S, Wiita B, Bachmann G. The accuracy of women performing vaginal pH self-testing. J Womens Health (Larchmt). 2008 May. 17(4):523-6. [Medline].
[Guideline] Huntzinger A. Guideline Briefs. Practice American Family Physician. Nov 2006. 74.
Sobel JD, Wiesenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A, et al. Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Engl J Med. 2004 Aug 26. 351(9):876-83. [Medline].
Brexafemme (ibrexafungerp) [package insert]. Jersey City, NJ: Scynexis, Inc. June 2021. Available at [Full Text].
Martens MG, Maximos B, Degenhardt T, Person K, Curelop S, Ghannoum M, et al. A Phase 3, Randomized, Double-Blind Study to Evaluate the Efficacy and Safety of Oteseconazole (VT-1161) Oral Capsules versus Fluconazole and Placebo in the Treatment of Acute Vulvovaginal Candidiasis Episodes in Subjects with Recurrent Vulvovaginal Candidiasis (ultraViolet). Presented at the Virtual IDWeek 2021. Open Forum Infectious Diseases. 2021 November. 8 (suppl 1):[Full Text].
Sobel JD, Chaim W. Treatment of Torulopsis glabrata vaginitis: retrospective review of boric acid therapy. Clin Infect Dis. 1997 Apr. 24(4):649-52. [Medline].
Sourced by Scynexis. SCYNEXIS Announces FDA Approval of Second Indication for BREXAFEMME® (ibrexafungerp tablets) for Reduction in Incidence of Recurrent Vulvovaginal Candidiasis. GlobalNewswire. Available at https://www.globenewswire.com/news-release/2022/12/01/2565906/0/en/SCYNEXIS-Announces-FDA-Approval-of-Second-Indication-for-BREXAFEMME-ibrexafungerp-tablets-for-Reduction-in-Incidence-of-Recurrent-Vulvovaginal-Candidiasis.html. December 1, 2022; Accessed: December 6, 2022.
Nachtigall LD. Use of low-dose premarin, estrace, and estring vaginally. Obstetrical and Gynecological Survey. 1998. 53(10S):62S-65S.
Suckling J, Lethaby A, Kennedy R. Local oestrogen for vaginal atrophy in postmenopausal women. Cochrane Database Syst Rev. 2006 Oct 18. CD001500. [Medline].
The North American Menopause Society. The role of local vaginal estrogen for treatment of vaginal atrophy in postmenopausal women: 2007 position statement of The North American Menopause Society. Menopause. 2007 May-Jun. 14(3 pt 1):355-69; quiz 370-1. [Medline].
Kroll R, Archer DF, Lin Y, Sniukiene V, Liu JH. A randomized, multicenter, double-blind study to evaluate the safety and efficacy of estradiol vaginal cream 0.003% in postmenopausal women with dyspareunia as the most bothersome symptom. Menopause. 2018 Feb. 25 (2):133-138. [Medline].
Henriksson L, Stjernquist M, Boquist L, Cedergren I, Selinus I. A one-year multicenter study of efficacy and safety of a continuous, low-dose, estradiol-releasing vaginal ring (Estring) in postmenopausal women with symptoms and signs of urogenital aging. Am J Obstet Gynecol. 1996 Jan. 174(1 Pt 1):85-92. [Medline].
Ayton RA, Darling GM, Murkies AL, Farrell EA, Weisberg E, Selinus I, et al. A comparative study of safety and efficacy of continuous low dose oestradiol released from a vaginal ring compared with conjugated equine oestrogen vaginal cream in the treatment of postmenopausal urogenital atrophy. Br J Obstet Gynaecol. 1996 Apr. 103(4):351-8. [Medline].
Eriksen PS, Rasmussen H. Low-dose 17 beta-estradiol vaginal tablets in the treatment of atrophic vaginitis: a double-blind placebo controlled study. Eur J Obstet Gynecol Reprod Biol. 1992 Apr 21. 44(2):137-44. [Medline].
Brossfield J. Herbal Therapies for Menopause. The Resident Reporter. 2000. 5(6):26-30.
Hirata JD, Swiersz LM, Zell B, Small R, Ettinger B. Does dong quai have estrogenic effects in postmenopausal women? A double-blind, placebo-controlled trial. Fertil Steril. 1997 Dec. 68(6):981-6. [Medline].
Lieberman S. A review of the effectiveness of Cimicifuga racemosa (black cohosh) for the symptoms of menopause. J Womens Health. 1998 Jun. 7(5):525-9. [Medline].
Nachtigall LB, LaGrega L, Lee WW. The effects of isoflavones derived from red clover on vasomotor symptoms and endometrial thickness. 9th International Menopause Society World Congress on Menopause. 1999.
Punyahotra S, Dennerstein L, Lehert P. Menopausal experiences of Thai women. Part 1: Symptoms and their correlates. Maturitas. 1997 Jan. 26(1):1-7. [Medline].
Chen J, Geng L, Song X, Li H, Giordan N, Liao Q. Evaluation of the efficacy and safety of hyaluronic acid vaginal gel to ease vaginal dryness: a multicenter, randomized, controlled, open-label, parallel-group, clinical trial. J Sex Med. 2013 Jun. 10(6):1575-84. [Medline].
Bergeron S, Binik YM, Khalifé S, Pagidas K. Vulvar vestibulitis syndrome: a critical review. Clin J Pain. 1997 Mar. 13(1):27-42. [Medline].
Solomons CC, Melmed MH, Heitler SM. Calcium citrate for vulvar vestibulitis. A case report. J Reprod Med. 1991 Dec. 36(12):879-82. [Medline].
Horowitz BJ. Interferon therapy for condylomatous vulvitis. Obstet Gynecol. 1989 Mar. 73(3 Pt 1):446-8. [Medline].
Harris G, Horowitz B, Borgida A. Evaluation of gabapentin in the treatment of generalized vulvodynia, unprovoked. J Reprod Med. 2007 Feb. 52(2):103-6. [Medline].
Marrazzo J. Vulvovaginal candidiasis. BMJ. 2002 Sep 14. 325(7364):586. [Medline]. [Full Text].

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Candida albicans photomicrograph. Courtesy of Centers for Disease Control and Prevention (CDC).

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Author

Jill M Krapf, MD, MEd, FACOG, NCMP, IF Associate Director, The Center for Vulvovaginal Disorders; Clinical Association Professor, Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences

Jill M Krapf, MD, MEd, FACOG, NCMP, IF is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Association of Professors of Gynecology and Obstetrics, American Congress of Obstetricians and Gynecologists, International Society for the Study of Vulvovaginal Diseases, International Society for the Study of Women’s Sexual Health, North American Menopause Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Nicole W Karjane, MD Associate Professor, Department of Obstetrics and Gynecology, Virginia Commonwealth University Medical Center

Nicole W Karjane, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, Association of Professors of Gynecology and Obstetrics, North American Society for Pediatric and Adolescent Gynecology

Disclosure: Received income in an amount equal to or greater than $250 from: Merck<br/>Served as Nexplanon trainer for: Merck.

Chief Editor

Christine Isaacs, MD Associate Professor, Department of Obstetrics and Gynecology, Division Head, General Obstetrics and Gynecology, Medical Director of Midwifery Services, Virginia Commonwealth University School of Medicine

Christine Isaacs, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists

Disclosure: Nothing to disclose.

Acknowledgements

Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine