Recurrent vaginal yeast infections

A vaginal yeast infection is considered to be recurrent when you have had four or more symptomatic infections, unrelated to antibiotic use, within 1 year. Severe or recurrent yeast infections are a problem for about 5% of affected women, sometimes related to diabetes, pregnancy, or a debilitating health condition.¹

If you have a recurrent vaginal yeast infection, your health professional may do a culture to confirm that yeast is present. You may also be tested for certain conditions that could be making you more vulnerable to yeast overgrowth, such as diabetes.

Recommended initial treatment for recurrent vaginal yeast infections includes vaginal medications for 7 to 14 days or a single dose of oral fluconazole 150 mg, with a second dose repeated 3 days later.^{2, 1}

Initial treatment is then followed by at least 6 months of maintenance therapy, which could be oral or vaginal medications. Current treatment recommendations are one of the following:³

• Clotrimazole vaginal suppositories, 500 mg, once a week
• Boric acid vaginal capsules, 600mg, twice a week.^{1, 4} Boric acid can kill types of yeast that can't be cured by azole antifungal medications.⁴
• Fluconazole, 100 to 150 mg, orally once a week
• Itraconazole, 400 mg, orally once a month or 100 mg, orally once a day
• Ketoconazole, 100 mg, orally once a day. Ketoconazole is associated with a rare but serious type of hepatitis. For this reason, it is not often used as treatment for vaginal yeast infections.⁵

Some women who are treated for recurrent yeast infections do not see improvement in their symptoms. These women may have another condition that is causing symptoms similar to a yeast infection. Additional testing and treatment may be needed.

Citations

1. 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.

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

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. 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.

5. Spence D (2003). Candidiasis (vulvovaginal). Clinical Evidence (12): 2490–2508.