Candida vulvovaginitis medical therapy

Jump to navigation Jump to search

Candida vulvovaginitis Microchapters


Patient Information


Historical Perspective




Differentiating Candidiasis from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History, Complications and Prognosis


History and Symptoms

Physical Examination

Laboratory Findings

X Ray


Other Imagining Findings

Other Diagnostic Studies


Medical Therapy


Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Candida vulvovaginitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides


American Roentgen Ray Society Images of Candida vulvovaginitis medical therapy

All Images
Echo & Ultrasound
CT Images

Ongoing Trials at Clinical

US National Guidelines Clearinghouse

NICE Guidance

FDA on Candida vulvovaginitis medical therapy

CDC on Candida vulvovaginitis medical therapy

Candida vulvovaginitis medical therapy in the news

Blogs on Candida vulvovaginitis medical therapy

Directions to Hospitals Treating Candidiasis

Risk calculators and risk factors for Candida vulvovaginitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]


Antifungal agents are indicated in candidiasis. Commonly used drugs include Amphotericin, Clotrimazole, Nystatin, Fluconazole and Ketoconazole. It is important to consider that Candida species are frequently part of the human body's normal oral and intestinal flora. Candidiasis is occasionally misdiagnosed by medical personnel as bacterial in nature, and treated with antibiotics against bacteria. This can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition.

Medical Therapy

1. Uncomplicated Vulvovaginal Candidiasis[1][2]

  • 1.1 Recommended Regimens
    • 1.1.1 Over-the-Counter Intravaginal Agents
      • Clotrimazole 1% cream 5 g intravaginally daily for 7–14 days OR
      • Clotrimazole 2% cream 5 g intravaginally daily for 3 days OR
      • Miconazole 2% cream 5 g intravaginally daily for 7 days OR
      • Miconazole 4% cream 5 g intravaginally daily for 3 days OR
      • Miconazole 100 mg vaginal suppository one suppository daily for 7 days OR
      • Miconazole 200 mg vaginal suppository one suppository for 3 days OR
      • Miconazole 1,200 mg vaginal suppository one suppository for 1 day OR
      • Tioconazole 6.5% ointment 5 g intravaginally in a single application
    • 1.1.2 Prescription Intravaginal Agents
      • Butoconazole 2% cream 5 g intravaginally in a single application OR
      • Terconazole 0.4% cream 5 g intravaginally daily for 7 days OR
      • Terconazole 0.8% cream 5 g intravaginally daily for 3 days OR
      • Terconazole 80 mg vaginal suppository one suppository daily for 3 days
    • 1.1.3 Oral Agent
    • Note: the creams and suppositories in these regimens are oil based and might weaken latex condoms and diaphragms. Patients should refer to condom product labeling for further information.
    • Note: Any woman whose symptoms persist after using an over-the-counter preparation or who has a recurrence of symptoms <2 months after treatment for Vulvovaginal Candidiasis should be evaluated clinically and tested.
    • Note: No substantial evidence exists to support using probiotics or homeopathic medications for treating Vulvovaginal Candidiasis.
  • 1.2 Management of Sex Partners
    • Uncomplicated Vulvovaginal Candidiasis is not usually acquired through sexual intercourse, and data do not support treatment of sex partners.
  • 1.3 Special Considerations
    • 1.3.1 Drug Allergy, Intolerance, and Adverse Reactions
      • Topical agents usually cause no systemic side effects.
      • Oral azoles occasionally cause nausea, abdominal pain, and headache.
      • Clinically important interactions can occur when oral azoles are administered with other drugs.

2. Complicated Vulvovaginal Candidiasis[1][2]

  • 2.1 Recurrent Vulvovaginal Candidiasis
    • Defined as three or more episodes of symptomatic Vulvovaginal Candidiasis in <1 year.
    • Preferred regimen: topical therapy for 7–14 days, OR fluconazole 100-mg, 150-mg, or 200-mg PO every third day for a total of 3 doses [days 1, 4, and 7].
    • Maintenance regimen: fluconazole 100-mg, 150-mg, or 200-mg PO weekly for 6 months. (If this regimen is not feasible, topical treatments used intermittently).
    • Note: C. albicans azole resistance is becoming more common, susceptibility tests, if available, should be obtained among symptomatic patients who remain culture positive despite maintenance therapy. These women should be managed in consultation with a specialist.
  • 2.2 Severe Vulvovaginal Candidiasis
    • Preferred regimen: either 7–14 days of topical azole or fluconazole 150 mg PO in two doses 72 hours apart.
  • 2.3 Non–albicans Vulvovaginal Candidiasis
    • The optimal treatment of non–albicans Vulvovaginal Candidiasis remains unknown; however, a longer duration of therapy (7–14 days) with a nonfluconazole azole regimen (oral or topical) is recommended.
    • If recurrence occurs, boric acid 600 mg gelatin capsule intravaginally once daily for 3 weeks is indicated.
  • 2.4 Management of Sex Partners
    • No data exist to support treating sex partners of patients with complicated Vulvovaginal Candidiasis.

3. Special Considerations[2]

  • 3.1 Pregnancy
    • Preferred regimen: topical azole for 7 days
    • Note: Epidemiologic studies indicate a single 150-mg dose of fluconazole might be associated with spontaneous abortion and congenital anomalies; therefore, it should not be used.
  • 3.2 HIV Infection
    • Treatment for uncomplicated and complicated Vulvovaginal Candidiasis among women with HIV infection should not differ from that for women who do not have HIV.
    • Long-term prophylactic therapy with fluconazole 200 mg weekly has been effective in reducing C. albicans colonization and symptomatic Vulvovaginal Candidiasis, however this regimen is not recommended for women with HIV infection in the absence of complicated Vulvovaginal Candidiasis.

4. Follow-Up

Follow-up typically is not required. However, women with persistent or recurrent symptoms after treatment should be instructed to return for follow-up visits.


  1. 1.0 1.1 "" (PDF).
  2. 2.0 2.1 2.2 "Vulvovaginal Candidiasis - STI Treatment Guidelines".