Treatment of Vaginal Yeast Infection

First-Line Treatment Options

The Infectious Diseases Society of America recommends using either a single 150 mg oral dose of fluconazole or a short course of topical azole therapy (3-7 days) for uncomplicated vaginal yeast infections, as both achieve equivalent cure rates of 80-90% 1
Fluconazole 150 mg as a single oral dose is the most convenient option for uncomplicated vulvovaginal candidiasis, according to the Clinical Infectious Diseases journal 2, 1

The Centers for Disease Control and Prevention recommends multiple equally effective topical intravaginal therapy options, including butoconazole 2% cream 5g intravaginally, clotrimazole 100 mg vaginal tablet, miconazole 200 mg vaginal suppository, terconazole 0.8% cream 5g intravaginally, and terconazole 80 mg vaginal suppository 3, 1

The Infectious Diseases Society of America recommends extended therapy for complicated infections, including fluconazole 150 mg every 72 hours for 3 doses or topical azole therapy for 7-14 days 1

The Infectious Diseases Society of America recommends a maintenance phase of fluconazole 150 mg once weekly for at least 6 months for recurrent infections, which achieves symptom control in >90% of patients 1, 2

The Centers for Disease Control and Prevention recommends that treatment should not differ based on HIV status, and identical response rates are anticipated for HIV-positive and HIV-negative women 1

The Centers for Disease Control and Prevention recommends confirming diagnosis before treatment, using a wet mount with 10% KOH to demonstrate yeast or pseudohyphae, and normal vaginal pH (≤4.5) 3, 1
The Centers for Disease Control and Prevention recommends that over-the-counter preparations should only be used by women previously diagnosed with vaginal yeast infection who have recurrence of the same symptoms, and seeking medical care if symptoms persist after OTC treatment or recur within 2 months 3