Treatment for Recurring Vaginal Candidiasis

Initial Induction Phase (10-14 Days)

The Infectious Diseases Society of America recommends treating recurring vulvovaginal candidiasis with 10-14 days of induction therapy using either a topical azole or oral fluconazole, followed by maintenance therapy with fluconazole 150 mg weekly for 6 months 1, 2
The initial induction phase achieves initial control of the recurrent episode before starting suppressive therapy, and can be done with either topical intravaginal azole therapy daily for 10-14 days or oral fluconazole 150 mg every 72 hours for 2-3 doses 1, 3, 4
Diagnosis should be confirmed with wet mount preparation using saline and 10% potassium hydroxide to demonstrate yeast or hyphae, and verify normal vaginal pH (4.0-4.5) 1, 2

The Infectious Diseases Society of America recommends fluconazole 150 mg orally once weekly for 6 months as the most convenient and well-tolerated regimen for maintenance suppressive therapy 1, 3, 4
Alternative maintenance options include topical clotrimazole 200 mg intravaginally twice weekly or clotrimazole 500 mg vaginal suppository once weekly 3, 5

The Infectious Diseases Society of America recommends addressing predisposing factors such as diabetes mellitus before initiating suppressive therapy 3, 5, 4
Expect recurrence after stopping maintenance therapy, with 40-50% of patients experiencing recurrence after cessation of the 6-month maintenance regimen 3, 5

For C. glabrata infections unresponsive to azoles, the Infectious Diseases Society of America recommends first-line treatment with topical intravaginal boric acid 600 mg in gelatin capsules daily for 14 days 1, 2
Second-line treatment options include nystatin intravaginal suppositories 100,000 units daily for 14 days 1, 2
Third-line treatment options include topical 17% flucytosine cream alone or combined with 3% amphotericin B cream daily for 14 days (requires compounding) 1, 3, 2

Azole-resistant C. albicans infections are extremely rare 3, 5, 4
Treatment should not differ based on HIV infection status, with identical response rates occurring in HIV-positive and HIV-negative women 3, 5, 2