Candidal vulvovaginitis in pregnancy should be treated with intravaginal clotrimazole or nystatin for at least 7 days. All are more or less equally effective. By mouth: ibrexafungerp, fluconazole as a single dose. For severe disease another dose after 3 days may be used.Short-course topical formulations (i.e., single dose and regimens of 1–3 days) effectively treat uncomplicated candidal vulvovaginitis. The topically applied azole drugs are more effective than nystatin. Treatment with azoles results in relief of symptoms and negative cultures in 80–90% of patients who complete therapy.The creams and suppositories in this regimen are oil-based and might weaken latex condoms and diaphragms. Treatment for vagina thrush using antifungal medication is ineffective in up to 20% of cases. Treatment for thrush is considered to have failed if the symptoms do not clear within 7–14 days. There are a number of reasons for treatment failure. For example, if the infection is a different kind, such as bacterial vaginosis (the most common cause of abnormal vaginal discharge), rather than thrush. Recurrent
For infrequent recurrences, the simplest and most cost-effective management is self-diagnosis and early initiation of topical therapy. However, women whose condition has previously been diagnosed with candidal vulvovaginitis are not necessarily more likely to be able to diagnose themselves; therefore, any woman whose symptoms persist after using an over the counter preparation, or who has a recurrence of symptoms within two months, should be evaluated with office-based testing.
Broad-spectrum antibiotics kill healthy bacteria in the vagina, such as Lactobacillus. These bacteria normally help to limit yeast colonization.Oral contraceptive use is also associated with increased risk of vaginal thrush. Pregnancy
In pregnancy, higher levels of estrogen make a woman more likely to develop a yeast infection. During pregnancy, the Candida fungus is more common, and recurrent infection is also more likely. There is tentative evidence that treatment of asymptomatic candidal vulvovaginitis in pregnancy reduces the risk of preterm birth. Lifestyle
While infections may occur without sex, a high frequency of intercourse increases the risk. Personal hygiene methods or tight-fitting clothing, such as tights and thong underwear, do not appear to increase the risk. Diseases
Those with poorly controlled diabetes have increased rates of infection while those with well controlled diabetes do not. The risk of developing thrush is also increased when there is poor immune function, as with HIV/AIDS, or in those receiving chemotherapy. Diet
A diet high in sugar may increase the risk of vaginal thrush; in some women, reducing sugar intake seems to reduce the risk of reoccurring vaginal thrush. Species of yeast responsible
While Candida albicans is the most common yeast species associated with vaginal thrush, infection by other types of yeast can produce similar symptoms. A Hungarian study of 370 patients with confirmed vaginal yeast infections identified the following types of infection:
Candida albicans: 85.7%
Non-albicans Candida (8 species): 13.2%
Saccharomyces cerevisiae: 0.8%
Candida albicans and Candida glabrata: 0.3%Non-albicans Candida are often found in complicated cases of vaginal thrush in which the first line of treatment is ineffective.