Management of Vaginal Candidiasis

Treatment Guidelines

The Centers for Disease Control and Prevention recommends a single 150 mg oral dose of fluconazole as first-line treatment for uncomplicated vaginal candidiasis, achieving >90% clinical cure rates 1, 2
For complicated vaginal candidiasis, the Centers for Disease Control and Prevention recommends fluconazole 150 mg every 72 hours for 2-3 total doses 3, 2, 4
The American College of Obstetricians and Gynecologists recommends confirming diagnosis before initiating therapy, using wet-mount preparation with 10% KOH demonstrating yeast or pseudohyphae, and verifying normal vaginal pH (≤4.5) 1, 2

The Centers for Disease Control and Prevention recommends a two-phase approach for recurrent disease (≥4 episodes per year), including an induction phase with fluconazole 150 mg repeated 3 days later, and a maintenance phase with fluconazole 150 mg orally once weekly for 6 months 3, 2, 4

The Centers for Disease Control and Prevention recommends avoiding oral fluconazole completely in pregnancy due to association with spontaneous abortion and congenital malformations, and using only 7-day topical azole therapy instead 2, 4

The Centers for Disease Control and Prevention recommends boric acid 600 mg intravaginal gelatin capsule daily for 14 days as first-line therapy for non-albicans species (particularly C. glabrata) 3, 4

The Centers for Disease Control and Prevention recommends that routine treatment of sex partners is not recommended, as vaginal candidiasis is not sexually transmitted 1, 6