Treatment of Vaginal Candida Infection

Diagnosis Confirmation

Diagnosis should be confirmed through wet-mount preparation with saline and 10% potassium hydroxide to demonstrate yeast or hyphae 1, 3
Normal vaginal pH (4.0-4.5) is associated with Candida infection 4, 3
Vaginal cultures should be obtained for patients with negative microscopy findings but suspected infection 3
Identifying Candida without symptoms should not lead to treatment as 10-20% of women normally harbor Candida in the vagina 4

The Centers for Disease Control and Prevention recommends topical options such as Clotrimazole 1% cream 5g intravaginally for 7-14 days, Clotrimazole 100mg vaginal tablet for 7 days, Miconazole 2% cream 5g intravaginally for 7 days, Butoconazole 2% cream 5g intravaginally for 3 days, and Tioconazole 6.5% ointment 5g intravaginally as single application 4, 5
The Infectious Diseases Society of America recommends oral fluconazole 150mg as a single dose for uncomplicated vulvovaginal candidiasis 1

For severe infection, the Centers for Disease Control and Prevention recommends fluconazole 150mg every 72 hours for 3 doses 1, 3
For non-albicans Candida infection, such as C. glabrata, the Infectious Diseases Society of America recommends Boric acid 600mg in gelatin capsule vaginally daily for 14 days 3
For refractory cases, the Infectious Diseases Society of America recommends topical 17% flucytosine cream alone or with 3% AmB cream for 14 days 2, 3

The Centers for Disease Control and Prevention recommends initial induction therapy with topical agent or oral fluconazole for 10-14 days, followed by maintenance therapy with fluconazole 150mg weekly for 6 months for recurrent vulvovaginal candidiasis 2, 3
This regimen achieves control of symptoms in >90% of patients 2
After stopping maintenance therapy, 40-50% recurrence rate can be expected 2

Treatment of vulvovaginal candidiasis should not differ based on HIV status 1, 2
Fluconazole should not be used during the first trimester of pregnancy 4, 5
Over-the-counter preparations should only be recommended for women previously diagnosed with VVC who experience recurrence of the same symptoms 4
Women whose symptoms persist after using OTC preparations or who experience recurrence within 2 months should seek medical care 4

Azole-resistant C. albicans infections are extremely rare but can occur after prolonged azole exposure 2

For uncomplicated infections with symptom resolution, follow-up is generally unnecessary 5