How is vaginal candidiasis treated?

Updated: Dec 04, 2018
  • Author: Hetal B Gor, MD, FACOG; Chief Editor: Michel E Rivlin, MD  more...
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Answer

For the purposes of treatment, vaginal candidiasis, also referred to as vulvovaginosis candidiasis (VVC), may be broadly classified as either complicated or uncomplicated, as follows:

  • Uncomplicated - Sporadic or infrequent VVC; mild-to-moderate VVC likely to be caused by C albicans and occurring in nonimmunocompromised women

  • Complicated - Recurrent VVC; severe VVC; VVC caused by a species other than C albicans or occurring in immunocompromised women

Recommended regimens for intravaginal agents are as follows:

  • Butoconazole 2% cream 5 g intravaginally for 3 days

  • Butoconazole 2% cream 5 g (butoconazole 1 sustained release), single intravaginal application

  • Clotrimazole 1% cream 5 g intravaginally for 7-14 days

  • Clotrimazole 100 mg vaginal tablet for 7 days

  • Clotrimazole 100 mg vaginal tablet, 2 tablets for 3 days

  • Miconazole 2% cream 5 g intravaginally for 7 days

  • Miconazole 100 mg vaginal suppository, 1 suppository for 7 days

  • Miconazole 200 mg vaginal suppository, 1 suppository for 3 days

  • Miconazole 1200 mg vaginal suppository, 1 suppository for 1 day

  • Nystatin 100,000 unit vaginal tablet, 1 tablet for 14 days

  • Terconazole 80 mg vaginal suppository, 1 suppository for 3 days

The recommended regimen for the oral agent fluconazole is a 150 mg oral tablet in a single dose. It should be kept in mind that the oil-based cream and suppositories might weaken latex condoms.

Patients are instructed to return only if symptoms persist or recur within 2 months of the onset of initial symptoms. Routine treatment of sex partners is not indicated.

Recommendations for complicated VVC are as follows:

  • Recurrent VVC (≥4 episodes of symptomatic VVC in 1 y) - 7-10 days of topical therapy or a 100 mg or 150 mg oral dose of fluconazole every third day for a total of 3 doses (days 1, 4, and 7); for maintenance, oral fluconazole 100 mg or 150 mg weekly for 6 months

  • Severe VVC - 7-14 days of topical azole therapy or 150 mg of oral fluconazole repeated in 72 hours; adjunctive use of nystatin cream or low-potency steroid cream may be beneficial

  • Non-albicans VVC - 7-14 days of nonfluconazole therapy; 600 mg of boric acid in a gelatin capsule vaginally twice daily for 14 days

  • VVC in compromised hosts - 7-14 days of topical therapy

  • VVC in pregnant patients - 7 days of topical agents; fluconazole is contraindicated


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