What is vaginal candidiasis?
Vaginal candidiasis, also called Candida vulvovaginitis, is a mycosis caused by the Candida fungus, usually Candida albicans. Other forms of Candida, such as Candida glabrata, can also cause vulvovaginitis, but are far less common.
Vulvovaginal candidiasis is one of the most common causes of vaginal itching and discharge, second only to bacterial vaginosis, an infection caused by the bacteria Gardnerella vaginalis. About 1 in 3 cases of vaginal discharge of infectious origin are caused by candidiasis.
Candida albicans is a common fungus of the vaginal flora and is naturally present in 20% of women. Its presence in itself poses no danger to healthy people. Candidiasis disease only arises when the population of fungi colonizing the skin increases too much. This increase can be stimulated by the use of antibiotics, contraceptives with high doses of hormones, diabetes, immune system changes, use of glucocorticoids, among others. Therefore, having Candida albicans colonizing the genital region does not necessarily mean that the woman will have the disease candidiasis.
Candida albicans can even be sexually transmitted in some cases, but most of the time the fungus originates from the person himself, usually from the gastrointestinal tract. Virgin women or women who have not had sexual intercourse for years can have episodes of vaginal candidiasis, which is why this mycosis is not considered a sexually transmitted disease.
When to treat Vaginal candidiasis
Candidiasis treatment is only indicated for women who have vaginitis complaints such as vaginal itching or burning, white discharge, or vaginal pain during urination or sexual intercourse.
Asymptomatic women do not need to take medication for candidiasis. The same goes for asymptomatic partners.
For treatment purposes, vaginal candidiasis is divided into two groups:
- Uncomplicated candidiasis.
- Complicated candidiasis.
Treatment of non-complicated candidiasis
To be considered an uncomplicated vaginal candidiasis, the infection must have the following characteristics:
- Be sporadic, occurring no more than 3 episodes per year.
- It does not cause severe symptoms.
- It must be caused by Candida albicans.
- It must occur in healthy, non-pregnant women.
For patients who fit this less severe form of infection, there are several options of vaginal candidiasis remedies and ointments.
In the uncomplicated form of candidiasis, both oral tablets and intravaginal topical treatments such as ointments, creams, or ovules are highly effective, with a cure rate of over 90%.
As the efficacy is similar, the choice of the most appropriate treatment, whether oral or intravaginal, should be decided together with the patient, according to the advantages and disadvantages of each form.
Taking candidiasis medication orally is usually more convenient, but the rate of side effects such as nausea, diarrhea or headaches is somewhat more common. Oral remedies also take about 24 to 48 hours longer to fully relieve the symptoms of vulvovaginitis compared to vaginal ointments or ovules.
Fluconazole tablet, 150 mg single dose, is the most commonly used treatment for vaginal candidiasis. A less convenient dosage option is Itraconazole 200 mg per day for 3 days.
When it comes to vaginal treatments, the range of options is much wider. Some of the most recommended regimens are:
- Clotrimazole cream 1% – 1 application (5 g) at night for 7 to 14 days.
- Clotrimazole cream 2% – 1 application (5 g) at night for 3 days.
- Clotrimazole vaginal tablet 500 mg – 1 tablet intravaginally at night in a single dose.
- Clotrimazole vaginal tablet 100 mg – 1 intravaginal tablet at night for 6 days.
Miconazole cream 2% – 1 application (5 g) at night for 7 to 14 days.
Miconazole ovule 200 mg – 1 intravaginal ovule at night for 3 days.
- Nystatin cream 100,000 IU – 1 application (4 g) at night for 14 days.
- Terconazole cream 0.8% – 1 application (5 g) at night for 3 to 5 days.
- Terconazole ovule 80 mg – 1 intravaginal ovule at night for 3 days.
- Butoconazole cream 2% – 1 application (5 g) as a single dose.
- Tioconazole ointment 6.5% – 1 application (5 g) as a single dose.
Pros and cons of treatment with pills, creams or intravaginal ovules
Currently, oral treatment is often more widely used than intravaginal creams or ovules, due to its simpler and shorter dosage. However, since the success rate in uncomplicated candidiasis is similar, the gynecologist can present the patient with the pros and cons of each form of treatment, leaving the patient to choose whichever she finds most comfortable.
Oral pills have the advantage of being cheaper and can be taken as a single oral dose. Topical treatments, on the other hand, have the advantage that they cause fewer adverse effects and symptom relief is quicker (one to two days before oral treatment).
Treatment of complicated candidiasis
To be considered a complicated vaginal candidiasis, the infection needs to have one or more of the following characteristics:
- Be recurrent, with more than 4 episodes per year.
- It must cause very severe symptoms.
- Be caused by a Candida other than Candida albicans, such as Candida glabrata.
- Affect pregnant women, patients with poorly controlled diabetes, or any disease that causes immunosuppression.
Recurrent vaginal candidiasis
Treatment of recurrent cases of candidiasis can be difficult, time consuming, and frustrating. Treatment should be based on the tripod: removal of predisposing factors (e.g. better control of diabetes, use of weaker pills or other contraceptive methods, avoidance of unnecessary use of antibiotics, avoidance of vaginal douching, etc.), elimination of the current infection, and prevention of recurrence.
The most indicated treatment for recurrent candidiasis is Fluconazole 150 mg orally, 3 doses, 72 hours apart. At the end of this regimen, preventive treatment is started with Fluconazole 150 mg, 1 tablet orally, once a week for 6 months.
An alternative for those not wanting oral treatment is to use any of the intravaginal regimens described in the previous section for 14 days, followed by Clotrimazole vaginal tablet 500 mg, 1 tablet intravaginally once a week for 6 months.
Vaginal candidiasis with intense symptoms
In case of non-recurrent candidiasis, but with very intense symptoms, treatment can be done with Fluconazole 150 mg orally, 3 doses 72 hours apart.
An alternative for those who do not want oral treatment is to use any of the intravaginal regimens described in the previous section for 10 to 14 days.
When the Candida type responsible for vulvovaginitis is not Candida albicans, treatment should be directed according to the Candida isolate. Candida type testing is usually done in cases of recurrent or difficult to clear infection.
Candida glabrata usually has low vaginal virulence and rarely causes symptoms, even when identified by culture. Every effort should be made to exclude other coexisting causes of symptoms before treating C. glabrata vaginitis.
- Treatment failure with azoles (miconazole, thioconazole, fluconazole, etc.) occurs in about 50% of patients.
- Moderate success (65 to 70%) can be achieved with intravaginal boric acid (600 mg vaginal capsule, once a day at night for two weeks). Caution: boric acid can be fatal if swallowed.
- Better results, with more than 90% cure can be achieved with intravaginal flucytosine cream or amphotericin B cream 4 to 10% (5 g every night for two weeks).
Some specialists use Nystatin cream 100,000 IU, 1 application (4 g) at night for 14 days, but this treatment has not yet been properly studied and the success rate is not fully known.
Candida krusei is usually resistant to oral Fluconazole, but responds well to intravaginal Cotrimazole, Miconazole, or Terconazole for 7 to 14 days at the doses listed above for Candida albicans.
If the patient prefers oral treatment, itraconazole 200 mg twice daily for 7 to 14 days or ketoconazole 400 mg daily for 7 to 14 days are options. Oral treatment has a higher incidence of side effects.
Candidiasis in pregnancy
In pregnant women, treatment should be done intravaginally. Cotrimazole and Miconazol for 7 days are the most used drugs.
Home Remedies for Candidiasis
There is no scientific evidence that the following home treatments work:
- Yogurt with lactobacillus orally or vaginally.
- Coconut oil.
- Eat or rub garlic in your vagina.
- Vinegar applications.
- Lemon juice applications.
- Eat apple.
- Vitamin supplements.
- Omega 3 .
Most common questions
Is there treatment for vaginal thrush in ointment or cream?
Yes, in women with uncomplicated genital candidiasis, the treatment can be done with creams based on Clotrimazole, Miconazole, Nystatin, Thioconazole, Butoconazole or Terconazole.
Is there a single dose vaginal candidiasis ointment or cream?
Yes, the single-dose topical treatments available are miconazole vaginal suppository, tioconazole 6.5% ointment, or 2% Butoconazole cream
How long does it take to cure vaginal thrush?
It depends. There are from single-dose treatments to therapies that last for 14 days. Symptoms usually begin to improve within 24 hours and resolve within 72 hours of starting treatment.
Is there home treatment for vaginal thrush?
No, there is no home treatment that has a scientific basis and is proven to be effective.
What is Recurrent Vaginal Thrush?
Recurrent vulvovaginal candidiasis or recurrent candidiasis is defined as four or more episodes of symptomatic infection within a 12-month interval.
When a woman has candidiasis, is it necessary to treat her partner as well?
This is a still controversial issue. Although sexual transmission of Candida species can occur, most experts do not recommend treating sexual partners as sexual activity is not a significant cause of infection or reinfection. Some physicians, however, choose to treat the partner when the woman has recurrent vulvovaginitis that is difficult to eradicate, although this approach is not supported in clinical studies.