Version July 2025
BV: bacterial vaginosis; DNA: deoxyribonucleic acid; VVC: vulvovaginal candidiasis.
* Characteristics of severe infection include extensive vulvovaginal involvement, skin fissures, and/or edema.
¶ Candida albicans is the causative organism in 80 to 90% of vulvovaginal infections. The remainder are mostly Candida glabrata or Candida krusei.
Δ In our practice, patients generally prefer oral to vaginal medication and single-dose to multidose therapy. However, as no approach has demonstrated superiority, all treatments are reasonable options.
◊ The incidence of fluconazole allergy is uncommon. Individuals with fluconazole allergy, including angioedema and severe rash, can receive other topical azoles, such as miconazole or clotrimazole, nystatin vaginal pessary, or vaginal boric acid.
§ There are multiple topical azoles, including butoconazole, clotrimazole, miconazole, nystatin, terconazole, and tioconazole. Duration of treatment varies by drug and dose. Topical azole creams can also be applied externally for symptom reduction. Additional discussions on treatment of vulvovaginal candidiasis are available in related UpToDate content and drug monographs.
