Vaginal medications for vaginal yeast infections

The following vaginal medications are available in combination with steroid creams for itching or inflammation. These are not usually needed to treat a vaginal yeast infection and are available only by prescription.

Vaginal antifungal medications are:

• Available without a prescription.
• Inserted into the vagina at bedtime, and some may also be applied to the genital area (vulva).
• Used with an applicator that supplies the correct amount of medication. Vaginal tablets and suppositories are also sold with an applicator to help insert the medication into the vagina.
• Able to be used externally. Yeast organisms can grow on the genital skin. Small amounts of some vaginal creams (such as miconazole [Monistat-Derm], clotrimazole/betamethasone dipropionate [Lotrisone], or nystatin/triamcinolone acetonide [Mycolog-II]) may reduce symptoms.

Treatment length varies depending on which vaginal medication you use. Single-day treatments are stronger and more convenient. But you may need longer treatment for a severe infection.

Generally, symptoms will diminish before the medication has completely eliminated the yeast infection. If treatment is discontinued before it is completed, the yeast infection may return, so it is important to complete the full medication treatment.

Vaginal antifungal medication kills yeast cells by destroying their cell membranes.

Vaginal antifungal treatment is recommended for:

• Occasional yeast infections.
• Yeast infection during pregnancy.
• Recurrent vaginal yeast infection. An initial treatment using oral and/or vaginal medication is followed by 6 months to 1 year of less frequent maintenance treatment.^{1, 2}

Vaginal medication treatment in pregnancy

Vaginal yeast infections commonly occur during pregnancy, probably related to the high estrogen levels. Consistently high estrogen is the most likely reason that treatment takes longer to cure a yeast infection during pregnancy.

The U.S. Centers for Disease Control and Prevention (CDC) recommends that only vaginal medications, such as cream or vaginal suppositories, be used for yeast infection treatment during pregnancy. Treatment takes longer than usual during pregnancy; 7 days of medication is recommended.³

If you are pregnant, do not use these nonprescription medications without first discussing your condition with your health professional.

All antifungal treatments offer an 80% to 90% yeast infection cure rate.^{4, 5, 6}

About 30% to 40% of women develop another yeast infection after discontinuing maintenance therapy with antifungal medication.²

Side effects of vaginal medications are generally mild. Local burning and irritation are most common with the higher-strength medications. Such skin reactions (including hives) can be distressing if the skin is inflamed.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Talk to your health professional if your symptoms continue or recur within 2 months of vaginal nonprescription medication treatment.

Women who experience four or more vaginal yeast infections a year should be evaluated for underlying conditions, such as diabetes.

Vaginal yeast infections appear to occur more often and may be more severe among women with human immunodeficiency virus (HIV) infection than among women without HIV. Women with HIV who have a vaginal yeast infection should follow the same treatment regimens as women without HIV.³

Treatment of sexual partners does not typically prevent recurrences and is not recommended. However, sexual partners with symptoms should be evaluated and treated appropriately.

Vaginal boric acid capsules can also be used to treat recurrent vaginal yeast infections, particularly those that don't respond to antifungal treatment. Do not use boric acid if you are pregnant.^{2, 6}

Check with your doctor or pharmacist to see whether you can get a generic form of a prescription medicine. Many generic medicines are now available to treat vaginal yeast infections. They are often less expensive than brand-name medicines.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

1. Ringdahl EN (2000). Treatment of recurrent vulvovaginal candidiasis. American Family Physician, 61(11): 3306–3312.

2. Eschenbach DA (2003). Vaginitis section of Pelvic infections and sexually transmitted diseases. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 585–589. Philadelphia: Lippincott Williams and Wilkins.

3. U.S. Department of Health and Human Services (2002). Sexually Transmitted Diseases Treatment Guidelines 2002 (CDC Publication Vol. 51, No. RR-6), pp. 45–48. Atlanta: U.S. Department of Health and Human Services.

4. Ressel GW (2002). CDC releases 2002 guidelines for treating STDs: Part I. Diseases characterized by vaginal discharge and PID. American Family Physician, 66(9): 1777–1778.

5. Marrazzo J (2002). Vulvovaginal candidiasis. BMJ, 325(7364): 586–587.

6. Kessel KV, et al. (2003). Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: A systematic review. Obstetrical and Gynecological Survey, 58(5): 351–358.