Vulvovaginal candidiasis

Fungal infection of the vulva and vagina caused by Candida spp. Presents with itching and cottage-cheese discharge. Treated with topical or systemic antifungals.

ICD-10 B37.34 drugs

Also known as: VVC, Vaginal yeast infection, Thrush

Drugs used for this condition

AClotrimazoleFirst line · Imidazole derivatives, topical antifungalsFirst-line for acute vulvovaginal candidiasis per CDC 2021 and Spanish SEGO 2023. Regimen: 200 mg vaginal tablet at bedtime for 3 days or 500 mg single dose, plus 1–2% cream to external genitalia twice daily for 1–2 weeks. Efficacy 80–90%. For recurrent candidiasis (>=4 episodes per year), add oral fluconazole 150 mg weekly for 6 months.
AFluconazoleFirst line · Antifungals, triazole derivativesFirst-line for uncomplicated vulvovaginal candidiasis. Single oral dose of 150 mg. Efficacy comparable to topical azoles but with greater convenience. For recurrent candidiasis (4 or more episodes per year), 150 mg once weekly for 6 months.
BItraconazoleThird line · Antifungal, triazoleTreats recurrent vulvovaginal candidiasis and fluconazole-resistant cases. SEGO keeps fluconazole as first-line.

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

DLactobacillus rhamnosus GG (LGG)Not recommended · Probiotic, Lacticaseibacillus rhamnosus GG strain. Supplement in Russia and Spain; in the EU and US available as food supplement or medical food; AEMPS does not register it as a medicineLGG is sold as «natural thrush remedy» in oral and intravaginal capsule forms. There are no quality data on LGG specifically in vulvovaginal candidiasis: small probiotic studies are heterogeneous and mostly involve other Lactobacillus species, with no systematic reviews reaching convincing conclusions. IUSTI 2018 lists fluconazole 150 mg single dose first-line for vulvovaginal candidiasis (or topical clotrimazole/miconazole); for recurrent – fluconazole 150 mg every 3 days × 3 doses + 6-month maintenance therapy. Lactobacilli are not in first-line guideline recommendations. If LGG was recommended as a substitute for antifungal therapy or in recurrent candidiasis without diabetes, HIV and other predisposing factor screening, consider seeking a second opinion from a gynaecologist.

How to read tiers A–F

Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.

AStrong evidence – first or second line in international guidelines
BRecommended in selected cases
CStudy data contradict each other
DBenefit not proven, no documented harm
FDocumented harm, or risk without benefit