Vulvovaginal candidiasis: Treatment of acute infection in pregnancy

VVC infection is not associated with adverse pregnancy outcomes but is treated to relieve symptoms. Pregnant patients are only treated with topical antifungals; we do not use oral fluconazole, oteseconazole, or ibrexafungerp because of concerns for potential fetal harm.

VVC: vulvovaginal candidiasis; RVVC: recurrent vulvovaginal candidiasis; BV: bacterial vaginosis.

* Appropriate diagnostic tests for VVC:

pH and microscopy of vaginal discharge
or
DNA probe tests, nucleic acid amplification tests (NAATs), or polymerase chain reaction methods. (Availability varies by institution.)

¶ Pregnant patients are treated only with topical antifungals; drug choice is based on prior patient response (if any), availability, and cost. Commonly used drugs include clotrimazole, miconazole, and nystatin. Alternate doses of the presented drugs, as well as other drugs, are available. Antifungal creams can be applied externally up to twice a day for relief of vulvar symptoms. Additional discussion of treatment during pregnancy is available in UpToDate content.

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Vulvovaginal candidiasis: Treatment of acute infection in pregnancy