Vaginal Yeast Infections: Medicine, Creams, and Pills

Written by Rebecca Buffum Taylor

Medically Reviewed by Poonam Sachdev on March 21, 2023

• Yeast Infection  Creams
• Yeast Infection Pills 
• Medication Tips for Yeast Infections
• When to Call Your Doctor

You can treat many yeast infections with over-the-counter creams or suppositories that you can buy without a prescription, especially if this isn’t the first time you’ve had a yeast infection and you recognize the symptoms.

But if you get yeast infections often or they’re severe, you may need a prescription medication. Not sure? Then you need to talk to your doctor.

For bad yeast infections, your doctor may prescribe an antifungal vaginal cream. These usually come packaged with an applicator that helps you measure the right dose.

You can get a range of similar yeast infection medications without a prescription, too. Some are creams you apply inside the vagina. Others are suppositories or tablets you place in your vagina and let dissolve. Most large drugstores and supermarkets sell them.

Many yeast infection treatments come in 1-day, 3-day, and 7-day strengths. Over-the-counter vaginal creams and other products you can buy often have the same ingredients to fight a yeast infection as the medication your doctor might prescribe, but in less-concentrated doses.

• Clotrimazole (Lotrimin and Mycelex)
• Miconazole (Micatin and Monistat)
• Tioconazole (Vagistat-1)

There are also creams that cover different strains of yeast. You’ll have to have a prescription for these:

• Butoconazole (Gynazole-1)
• Terconazole (Terazol)

In general, the more concentrated the drug, the shorter the time you have to take it. A vaginal cream that has the number 7 after its name, for instance, would usually be used for 7 days. If the same product name had a 3, it would be a more concentrated version of the vaginal cream and you’d only need it for 3 days.

Your doctor may also prescribe a steroid cream for a few days to ease more serious inflammation, redness, and soreness at the opening of the vagina and the surrounding tissue, called the vulva. 

Over-the-counter yeast infection creams

Vaginal creams without prescriptions also come with applicators that measure the right dose. Read all package directions carefully first. Vaginal creams can be messy and may leak out during the day, so — depending on how bad your infection is — you might want to use them only at bedtime.

When you use a vaginal cream that’s oil-based, you may need to use birth control that’s not a condom or diaphragm, or skip sex while you’re using the cream. That’s because the oil in the cream could damage the latex in a condom or diaphragm.

Yeast infection suppositories

Medications in vaginal creams (such as clotrimazole and miconazole) may also be available as vaginal tablets or suppositories. You put these into your vagina and let them dissolve. Some brands call them “ovules” because they’re oval-shaped. These products often come packaged with a plastic inserter that helps you get the medication to the right place.

One benefit of a suppository is that it’s less messy than a vaginal cream and less likely to ooze out during the day. Another benefit of tablets or suppositories is that you use the doses for fewer days, so you get relief from your symptoms sooner.

Safety tips for OTC yeast infection treatment

Before you use any of these products, you need to know for sure that you have a yeast infection, not something else. See your doctor if you’re not sure because using the wrong medicine can make an infection harder to diagnose.

Always follow the package directions exactly. Pay special attention to how often to use the product and how much to use. You need to get those two things right because the dose targets the growth cycle of the yeast.

Complete the whole treatment, even if you feel better.

Antifungal medications can change the way some drugs work. Talk to your doctor or pharmacist before taking an antifungal if you are taking other medications.

No matter which yeast infection treatment you try, see your doctor if your symptoms don’t clear up after you finish it.

If you have a severe infection, your doctor might prescribe an oral medication. The new drug ibrexafungerp (Brexafemme) is taken twice a day for one day and targets the specific fungal cells behind the infection. Fluconazole (Diflucan) is a pill that kills fungus and yeast throughout your body.  You would take fluconazole for a week — every third day (days 1, 4, and 7) — initially, for three doses total. Then, your doctor might have you take it weekly for 6 months to make sure the yeast infection doesn’t come back. Side effects for either include stomach upset, diarrhea. or headaches for a short time afterward.

You shouldn’t take either of these oral medications to treat yeast infections if you’re pregnant.

The antifungal oteseconazole (Vivjoa) has been approved for people who have repeated infections and who are not able to get pregnant, either because they’re postmenopausal or are permanently infertile. Infertility might be because you’ve had your uterus or your ovaries and fallopian tubes removed, or you’ve had your tubes tied (tubal ligation).  

Take the full course. Use all the pills or creams, even if your symptoms go away before you run out of the medicine.

Keep in mind that vaginal creams, vaginal tablets, and suppositories may be made with oil, which can damage condoms and diaphragms. So you’ll need to use another birth control method or not have sex during treatment if you don’t want to get pregnant.

Never take any medication — or even use a nonprescription vaginal cream — while you’re pregnant unless you’ve spokento your doctor about it first.

Reach out to your doctor or pharmacist if you have any questions about your prescription and how to take your medicine. Check in with your doctor’s office if your symptoms don’t disappear after you finish taking all your medicine as prescribed.

See your doctor if you have four or more vaginal yeast infections in a year. It could be a condition called recurrent vulvovaginal candidiasis. It’s not common, but if you have it, you may need to take an antifungal medication for up to 6 months.

Frequent, repeated yeast infections can also be a sign of a resistant strain or more serious condition, including untreated diabetes. Your doctor can help you figure out what the problem is.

Top Picks

10 Ways to Prevent Candidal Vulvovaginitis

Written by WebMD Editorial Contributors

Medically Reviewed by Neha Pathak, MD on September 20, 2021

If you’re like 75% of women, you’ll get at least one yeast infection during your lifetime. Half will get two or more.

You’re more likely to get one when you:

• Are pregnant
• Have diabetes
• Have a weakened immune system
• Take antibiotics
• Use birth control with high doses of the hormone estrogen
• Use douches or vaginal sprays

It may not be possible for all women to prevent yeast infections, but here’s what you can do to lower your odds.

1. Wear breathable underwear. Cotton is your best choice. It doesn’t hold onto heat or moisture. It will help keep you dry.
2. Keep things loose. Make sure your jeans, skirts, underwear, yoga pants, tights, pantyhose, etc. aren’t too snug. They can boost your body temperature and increase the amount of moisture around your private parts. That raises your chances for a yeast infection.
3. Don’t douche. “Feminine hygiene products” like douches can disrupt the balance of bacteria in your vagina by removing some of the good bacteria that’s supposed to be there to fight off infections. And skip the scent in feminine products. This includes bubble baths, soaps, sprays, tampons, and pads.
4. Avoid hot tubs and extra hot baths. Hot and damp are never your friends.
5. Change out of wet clothes. Don’t sit in a wet bathing suit after you go swimming or damp workout gear after the gym. Change into dry clothes right away.
6. In the bathroom, always wipe from front to back.
7. When on your period, change your tampons, pads, and panty liners often.
8. Manage your diabetes. If you have it, be sure to keep an eye on your blood sugar levels and keep them under control.
9. Use antibiotics only when you have to. You don’t need them for conditions like a cold, because they don’t do anything against a virus. If you don’t have to, don’t take them.
10. Eat yogurt that contains active cultures to add to the good bacteria that help your body control yeast.

© 2021 WebMD, LLC. All rights reserved. View privacy policy and trust info

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Remedies for thrush: tablets, suppositories, ointments

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Encyclopedia

Diseases of the intimate zone

Vulvovaginal candidiasis (or “thrush”) is an infectious lesion accompanied by inflammation of the vaginal mucosa, which is caused by fungi of the genus Candida.

The author of the article

Molchanov Oleg Leonidovich

Gynecologist, reproductive specialist, doctor of medical sciences.

Thrush

When “thrush” characteristic symptoms are observed: microorganisms and are present in small amounts on mucous membranes and human skin ^1.2 . However, under certain unfavorable conditions, yeast-like fungi begin to actively multiply and lead to disease.

Risk factors for the development of thrush:

The presence of chronic diseases and immunodeficiency conditions (HIV infection, diabetes mellitus, etc.)

Chronic stress and emotional overstrain

Irregular and / or unbalanced diet 900 03

Pregnancy

Frequent use of antibiotics, glucocorticosteroids, active hormonal contraception

Alcohol and smoking abuse

How is thrush treated?

Antifungal agents are used to treat thrush. These funds are systemic (tablets taken by mouth), as well as local – are produced in the form of vaginal tablets, suppositories, solutions and creams. The choice of drugs is based on various parameters: the severity of inflammation, the sensitivity of Candida fungi to a particular drug, the state of the woman’s immune system and the presence of concomitant diseases, as well as the convenience and ease of use ² .

How to treat thrush? Watch in a short video by Professor, Doctor of Medical Sciences, Evgenia Valerievna Shikh

Classification of drugs for “thrush”

Antifungal agents differ in chemical structure, on the basis of which they are divided into several classes of drugs that differ in the mechanism of action and a number of effects:

• Azoles
• Combinations
• Other antifungals

Antifungal drugs of various groups used to treat thrush

Sertaconazole (original Zalain®)

Characteristics

The unique structure of the sertaconazole molecule includes imidazole and benzothiophene derivatives, which enhance each other’s actions, thereby having an antifungal effect with a vengeance ²⁵ .

What is the difference between sertaconazole for the treatment of thrush? Watch in a short video of the professor, doctor of medical sciences, Shikh Evgenia Valerievna.

Action features

Sertaconazole, being a member of the azole class, has a special chemical structure that combines an imidazole ring and benzothiophene. The imidazole ring is “responsible” for the disruption of the normal functioning of the cell membrane of the fungus, due to which its growth stops and the ability to reproduce is blocked. Benzothiophene is directly integrated into the cell wall, after which the death of the fungal cell occurs. Thus, preparations based on sertaconazole have both fungistatic (stop the growth and reproduction of the fungus) and fungicidal (contribute to its death) effect ¹² . The third type of action against fungi of the genus Candida by sertaconazole is its ability to prevent the transition of a fungal cell from a saprophytic (inactive) form to a potentially invasive or active one (capable of incorporating into mucosal cells and causing inflammation) ¹³ .

Thus, sertaconazole has a unique triple mechanism of action against fungi of the genus Candida.

A number of studies have demonstrated a high sensitivity of fungi to sertaconazole compared to other azole antifungals ^13.14 . One explanation for this is that sertaconazole is a more modern drug from the azole group, which may be associated with fewer cases of resistance or addiction of fungi to this therapy. Sertaconazole has a broad spectrum of action against pathogenic fungi (Candida albicans, C. Tropicalis, C. Spp., Pityrosporum orbiculare), dermatophytes (Trichophyton and Microsporum) ¹⁴ .

The drug has an antibacterial effect against streptococci and staphylococci ²² , relieves itching ²⁴ and inflammation ²³ .

Dosage and administration regimen

Zalain ^® is presented on the basis of sertaconazole in 2 forms:

• Cream Zalain ^® for external use

For vaginal use of Zalain suppositories ^®

For the treatment of thrush: single administration of 1 Zalain suppository ^® into the vagina. A high concentration of sertaconosal, the active ingredient Zalain ^® suppositories, persists for 7 days. Such a long-term effect is ensured due to the property of lipophilicity – the ability of sertaconazole to dissolve in lipid (fat) cell structures. If symptoms persist, it is recommended to re-insert another 1 suppository into the vagina after 7 days ¹⁵ .

Cream Zalain ^® for external use

For the treatment of thrush: cream Zalain ^® is used for lesions of the external genitalia to reduce the severity of itching, burning and other discomfort in the area of ​​the labia majora and minora.

It is recommended to apply to the affected areas of the skin 2 times a day. The duration of treatment is 4 weeks.

Fluconazole

Characteristics

Triazole antifungal (azole class)

Features of action

Like many other antifungal agents, fluconazole acts on the cell wall of the fungal cell. Basically, it delays or blocks the action of certain enzymes (special protein substances) that are necessary for the normal functioning of the outer membrane of the fungal cell, and when it is destroyed, the death of the fungus itself occurs (fungicidal effect) ³ .

Preparations containing fluconazole are available in capsule form and are used to treat various types of fungal infections, since this substance penetrates into all body fluids in the body (including vaginal secretions).

Dosage and administration regimen

Fluconazole capsules are used in various dosages for the treatment of various types of fungal infections. For example, with common fungal infections (generalized candidiasis), the dose of the substance should be 400 mg per day, and for the treatment of vulvovaginal candidiasis, 150 mg of fluconazole is used once ⁴ . The duration of treatment with drugs with fluconazole depends on the type of fungal disease and is determined individually.

For thrush: Fluconazole 150 mg is taken as a single oral dose.
Fluconazole is not recommended for use during pregnancy and while breastfeeding. Preparations with fluconazole can be used to prevent recurring episodes of vulvovaginal candidiasis ² , however, the development of resistance of fungi to exposure to this substance should be taken into account ⁵ .

Ketoconazole

Feature

Antifungal agent of the imidazole series (azole class)

Features of action

Ketoconazole has activity against yeast fungi and dermatophytes6. The mechanism of its action is associated with inhibition of fungal cell division, as well as disruption of their vital activity by affecting cell permeability, which can cause the death of the fungus (fungistatic + fungicidal effect) ⁷ .

Dosage and administration regimen

Preparations based on ketoconazole are available in the form of tablets (for the treatment of fungal infections of internal organs and other localizations, as well as for common forms of mycoses), shampoos (for the treatment of fungal infections of the scalp), ointments (for external treatment of fungal infections of the skin, nails), vaginal suppositories (for the treatment of thrush in women).

The dosage of ketoconazole depends on the location of the lesion, the severity of the disease, the age, body weight of the person and comorbidities. Ketoconazole is not used during pregnancy and lactation. Tablets for adults are recommended in a daily dose of at least 200 mg and not more than 400 mg. The ointment is applied to the affected areas with a thin layer once a day ⁴ .

Clotrimazole

Characteristics

Antifungal drug – a synthetic derivative of imidazole (a class of azoles).

Features of action

It affects the enzymatic activity of cell membranes, stopping the division of fungal cells (fungistatic effect). May exhibit a fungicidal effect in high concentrations ¹⁰ .

Dosage and administration regimen

Preparations with clotrimazole for external use are available in the form of ointments, creams and solutions, vaginal tablets. Ointment and cream with clotrimazole are applied to the affected areas 2-3 times a day, the duration of treatment is determined in a particular case, but is at least 1 week (average 2-3 weeks) ⁴ .

For the treatment of thrush: appoint 1 suppository 200 mg at night for 3 days or 1 suppository 100 mg for 6 days. The literature describes cases of insensitivity of fungi to therapy with clotrimazole ¹¹ .

Nystatin

Characteristics

Antifungal drug from the group of polyene antibiotics. Substances from this group are produced by special microorganisms of the genus Streptomyces.

Features of action

Nystatin disrupts the vital activity of fungal cells, stops their growth and reproduction (fungistatic effect).

Widely used to treat certain types of fungal infections, in particular vulvovaginal candidiasis (including during pregnancy) caused by fungi of the genus Candida, as well as fungal infections of the skin and internal organs ² .

Nystatin is poorly absorbed from the gastrointestinal tract, resulting in poorer efficacy in preventing fungal infection compared to, for example, the azole group of drugs ¹⁶ .

Dosage and administration regimen

Tablets with nystatin are prescribed for candidiasis of internal organs, 500,000 IU 4-8 times a day. Ointment with nystatin is prescribed in the form of applications to the areas of the skin affected by the fungus 2 times a day. Rectal suppositories are used in the same mode for the treatment of candidiasis of the lower intestines ⁴ .

For the treatment of thrush: Vaginal suppositories with nystatin are used 2 times a day for the treatment of vaginal candidiasis. The course of treatment with any kind of drugs with nystain should not be shorter than 7 days, even if the condition improved before ¹⁷ .

Natamycin

Characteristics

Another antifungal drug from the group of polyene antibiotics.

Features of action

It disrupts the transport processes of fungal cells, depriving them of all energy substrates. As a result, the fungus cell loses the ability to reproduce, and then its death occurs (fungicidal effect) ¹⁸ .

Used for the treatment and prevention of fungal infections of the skin and mucous membranes, including the treatment of vulvovaginal candidiasis. Mushrooms practically do not develop resistance (insensitivity) to its action ¹⁸ .

Dosage and administration regimen

Oral forms of preparations with natamycin are used at a dose of 100 mg with a frequency of administration 4 times a day. 2% ointment with natamycin is applied externally, applied to the skin 1-2 times a day ⁴ .

For the treatment of thrush: Vaginal suppositories are used 1-2 times a day to treat vaginal candidiasis. The duration of treatment with natamycin preparations is determined individually, but it is always recommended to continue treatment for a few more days after symptoms have improved.

Povidone-iodine

Description

Local antiseptic preparation. Available in the form of vaginal suppositories.

Features of action

Active iodine, which is released from the active substance povidone-iodine, has a neutralizing effect on the cell wall of fungi, leading to cell death ¹⁹ .

Dosage and administration regimen

In case of candidiasis, 1 suppository is injected into the vagina 1 time per day for 7 days. It is also recommended as a prophylaxis before surgical or diagnostic interventions in the vagina.

For the treatment of thrush: 1 vaginal suppository 200 mg once a day for 7 days.
The drug is not used during pregnancy, breastfeeding and in women who have thyroid disease ⁴ .

Thus, a huge number of antifungal agents are currently used to treat vulvovaginal candidiasis (“thrush”). The choice of the drug depends primarily on the type of fungus that caused the disease (Candida albicans or Candida non-albicans), the presence or absence of a mixed infection (when, along with an increased number of fungi in smears from the vagina, other pathogenic flora is detected), as well as on the mechanism the action of the drug and its additional effects, the form of release of the drug, the duration of treatment. Special conditions of a woman (pregnancy, lactation, etc. ) must be taken into account.

Contents

Sertaconazole

Fluconazole

clotrimazole

Nystatin

Natamycin

Povidone-iodine

0% read

Zalain® Suppositories

Sertaconazole-based Zalain ^® preparations can be called a universal remedy for the treatment of thrush, because they:

• have a wide spectrum of action against fungal cells and a number of other vaginal pathogens
• active against both Candida albicans and non-albicans
• have a triple action on the cells of Candida fungi (fungistatic, fungicidal, prevents the transition of the inactive form of the fungus into pathogenic)
• preparations Zalain ^® are easy to use (the course of treatment with suppositories is only 1 day)
• remain active during menstruation
• the use of drugs in women during pregnancy and lactation is acceptable if the potential benefit to the mother outweighs the possible risk to the fetus or child

Only 1 suppository per course

Local effect of the drug

Absorption of sertaconazole into the bloodstream does not occur ¹³

May be used during pregnancy and lactation*

*as prescribed by a doctor if the benefits outweigh the risks

Where to buy Zalain® Suppositories

Instruction

Prevention of thrush

In recent years, there has been an increase in recurrent (repeating) forms of thrush and the development of fungal resistance to antifungal drugs. In this regard, great attention is paid to the prevention of the occurrence of vulvovaginal candidiasis ²⁰ .

Fungi that cause various diseases in humans (including vulvovaginal candidiasis), acquire aggressive properties and actively multiply in conditions associated with the use of antibiotics, violation of microflora and non-compliance with the rules of intimate hygiene. Therefore, it is important to follow the basic recommendations, following which you can successfully prevent thrush:

Avoid casual sex

Use a barrier method of protection during sexual intercourse (condoms)

Give up panty liners, synthetic underwear

Observe daily rules of intimate hygiene

Get a preventive examination by a gynecologist once a year

Give up bad habits

hygiene. When choosing these products, it is important to pay attention to the composition, which should not contain aggressive chemicals, alcohol, alkali, dyes.

For example, the cosmetic Zalagel ^® Intim contains tea tree oil, which has antibacterial, anti-inflammatory properties, helps to soothe itching and burning. And thanks to betaine, the gel prevents dryness of the intimate area, maintaining the physiological balance of the skin and external mucous membranes. Zalagel ^® Intim is recommended to be used once a day for regular intimate hygiene of the external genital organs or twice a day, morning and evening, in case of irritation or discomfort in the vulva ²¹ .

Frequently Asked Questions

Is there a difference in the effectiveness of different forms of drugs for the treatment of thrush?

Answer: Efficiency depends on the active substance and the sensitivity of pathogens to it.

Can tablets and suppositories be used at the same time to treat thrush?

Answer: The question of the treatment regimen is decided by a specialist, so be sure to seek specialized advice. When using vaginal suppositories Zalain ^® it is possible to use other means on the recommendation of a specialist. For complete information about Zalain ^® Suppositories, see the instructions for the drug.

Do I need to be re-examined after a course of treatment for thrush?

Answer: Cure in the case of thrush is established when the symptoms of the disease have completely stopped, and during repeated laboratory examination, a high amount (more than 10 ⁴ CFU) of fungi of the genus Candida. Therefore, to confirm the cure of the disease, a repeated clinical and laboratory examination is necessary (usually prescribed 10-14 days after treatment).

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References

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2. Federal clinical guidelines for the management of patients with urogenital candidiasis. / ROAG / Moscow – 2020
3. E.A. MEZHEVITINOVA, P.R. ABAKAROV, Sh.M. POGHOSYAN. USE OF FLUCONAZOLE IN WOMEN OF REPRODUCTIVE AGE WITH VULVOVAGINAL CANDIDIOSIS. FSBI “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov” of the Ministry of Health of the Russian Federation. Journal MEDICAL COUNCIL • No. 13, 2018, 10.21518/2079-701X-2018-13-96-102
4. Directory GRLS (State Register of Medicines)
5. Zheltikova T.M. MONITORING THE RESISTANCE OF CLINICAL YEAST STRAINS OF THE GENUS CANDIDA TO FLUCONAZOLE (BRIEF REVIEW). Medical advice. 2017;(2):70-74. https://doi.org/10.21518/2079-701X-2017-2-70-74
6. Frank C. Odds Spectrum of activity of oral antifungals, Proceedings of a Symposium at the 18th International Congress of Dermatology
7. Gupta AK, Lyons DC. The Rise and Fall of Oral Ketoconazole. J Cutan Med Surg. 2015 Jul-Aug;19(4):352-7. doi: 10.1177/1203475415574970. Epub 2015 Mar 5. PMID: 25775613.
8. Xu Y, Lu H, Zhu S, Li WQ, Jiang YY, Berman J, Yang F. Multifactorial Mechanisms of Tolerance to Ketoconazole in Candida albicans. Microbiol Spectr. 2021 Sep 3;9(1):e0032121. doi: 10.1128/Spectrum.00321-21. Epub 2021 Jun 23. PMID: 34160280; PMCID: PMC8552639
9. Crowley PD, Gallagher HC. Clotrimazole as a pharmaceutical: past, present and future. J Appl Microbiol. 2014 Sep;117(3):611-7. doi: 10.1111/jam.12554. Epub 2014 Jun 30. PMID: 24863842
10. Ausili A, Yakymenko I, Teruel JA, Gómez-Fernández JC. Clotrimazole Fluidizes Phospholipid Membranes and Localizes at the Hydrophobic Part near the Polar Part of the Membrane. biomolecules. 2021 Sep 2;11(9):1304. doi: 10.3390/biom11091304. PMID: 34572517; PMCID: PMC8464689
11. Sobel JD. Vulvovaginal candidosis. Lancet. 2007 Jun 9;369(9577):1961-71. doi: 10.1016/S0140-6736(07)60917-9. PMID: 17560449.
12. Carrillo-Muñoz AJ, Tur-Tur C, Cárdenes DC, Estivill D, Giusiano G. Sertaconazole nitrate shows fungicidal and fungistatic activities against Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum, causative agents of tinea pedis. Antimicrob. Agents Chemother. 2011;55(9):4420-4431
13. Croxtall JD, Plosker GL. Sertaconazole: A review of its use in the management of superficial mycoses in dermatology and gynaecology. Drugs 2009; 69(3): 339–59.
14. Plosker GL. Sertaconazole. A Review of Its Use in the Management of Superficial Mycoses in Dermatology and Gynaecology. Drugs.2009;69(3):339-359.
15. According to the official instructions for use of the drug Zalain (State Register of Medicines https://grls. rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=3bd5386b-0075-434d-a6ef-74ab056650ae)
16. Clarkson JE, Worthington HV, Eden OB. Interventions for preventing oral candidiasis for patients with cancer receiving treatment. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD003807. doi: 10.1002/14651858.CD003807.pub3. PMID: 17253497; PMCID: PMC6746214
17. Young GL, Jewell D. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database Syst Rev. 2001;(4):CD000225. doi: 10.1002/14651858.CD000225. PMID: 11687074
18. Malova I.O., Petrunin D.D. Natamycin is an antifungal agent of the class of polyene macrolides with unusual properties // Bulletin of Dermatology and Venereology. – 2015. – T. 91. – No. 3. – C. 161-184. doi: 10.25208/0042-4609-2015-91-3-161-184
19. Petersen EE, Weissenbacher ER, Hengst P, Spitzbart H, Weise W, Wolff F, Dreher E, Ernst U, Della Casa V, Pohlig G, Graf F, Kaiser RR. Local treatment of vaginal infections of varying etiology with dequalinium chloride or povidone iodine. A randomised, double-blind, active-controlled, multicentric clinical study. Arzneimittelforschung. 2002;52(9):706-15. doi: 10.1055/s-0031-1299955. PMID: 12404887.
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24. Kaur S., Sur R., Liebel F.T., Southall M.D. Induction of Prostaglandin D2 through the p38 MAPK Pathway Is Responsible for the Antipruritic Activity of Sertaconazole Nitrate. J Invest Dermatol. 2010;130(10):2448-2456. doi: 10.1038/jid.2010.152.
25. Carrillo-Muñoz AJ, Tur-Tur C, Giusiano G, Marcos-Arias C, Eraso E, Jauregizar N, Quindós G. Sertaconazole: an antifungal agent for the topical treatment of superficial candidiasis. Expert Rev Anti Infect Ther. 2013 Apr;11(4):347-58. doi: 10.1586/eri.13.17. PMID: 23566144.

This article is an expression of the author’s position.

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Effective vaginal and thrush preparations for women

Authors of the article

category

Thrush

Saprykina Lyudmila Vitalievna

Candidate of Medical Sciences, Associate Professor of the Department of Obstetrics and Gynecology, Faculty of Medicine, Russian National Research Medical University. N.I. Pirogova, obstetrician-gynecologist of the highest qualification category.

Thrush or vulvovaginal candidiasis (VVC) is a disease that occurs at least once in 75% of females, and more than once in 40-50% of women of reproductive age. As a rule, thrush occurs in an acute form, but in 10% of cases it becomes recurrent. Viral infections play a significant role in the development of relapses. Often, genital viral infections are asymptomatic, while viruses can create favorable conditions for the development of inflammatory diseases. The reason for this is viral-fungal and viral-bacterial associations, which significantly disrupt the local immunity of the vagina. It should be understood that until local immunity and microflora are restored, it is unlikely to get rid of the disease forever. The “vicious circle” of inflammation will start again and again every time a woman’s body is exposed to provoking factors.

What is candidiasis?

Thrush is a lesion of the genital mucosa caused by a fungus of the genus Candida. This name was given to vulvovaginal candidiasis due to the fact that during the intensive reproduction of a unicellular fungus, a whitish coating is created on the surface of the vulva and vaginal mucosa.

The following microorganisms are of clinical importance:

• Candida albicans (from albus – white) – is the causative agent of thrush in 90% of cases.
• Candida non-albicans – cause a similar clinic, but due to structural features, this group of fungi is resistant to classical antimycotic drugs, which complicates the treatment process.

The fungus begins to actively multiply when a woman’s immunity decreases or the composition of the vaginal microflora is disturbed.

Clinic

Vulvovaginal candidiasis is accompanied by itching, burning and pathological discharge.

Additional signs that indicate the presence of thrush include:

• increased itching after sports or water procedures;
• redness and swelling of the skin, vulvar mucosa;
• discomfort and burning when urinating;
• pain during intercourse, increased itching after intimacy.

Diagnosis

If a woman is concerned about burning, itching and vaginal discharge of a white or yellowish tint, she should consult a gynecologist. He will conduct a survey, examination and take a vaginal swab to determine the causative agent of the infection. With light microscopy, yeast fungi with pseudomycelium can be detected. In some cases, such as when a clinician suspects Candida non-albicans VVC, the laboratory cultures this fungus in special media (eg, Sabouraud’s medium, which uses maltose or dextrose) to identify the pathogen and determine susceptibility to specific antimycotic drugs. The polymerase chain reaction (PCR) method is also used, which detects the DNA of the pathogen. An additional PCR study for viruses makes it possible to detect viral-fungal associations, the treatment of which necessarily involves local antiviral and immunostimulating therapy. Otherwise, a sluggish inflammatory process in the vagina will provoke relapses of thrush.

How to treat thrush?

Depending on the severity of the course, the frequency of relapses, previous treatment and its effectiveness, as well as the sensitivity of the detected fungus to antifungal drugs, the doctor individually selects etiotropic (antifungal) therapy. Antimycotics directly affect the pathogen, can cause the death of fungi and disrupt the process of their division. Antifungal drugs are of general and local action.

Systemic agents against candidiasis

Systemic drugs are used for recurrent thrush. They are presented as tablets or capsules that the patient takes orally. For the treatment of complicated candidiasis, intravenous antimycotics may be prescribed. Drugs of general action enter the bloodstream and are carried with the blood to all organs and tissues. In drugs that have an effect on the whole body, the following active substances are often present:

• fluconazole;
• nystatin.

They contribute to the eradication of the pathogen.

To quickly get rid of the symptoms of thrush, it is recommended to additionally use drugs with a local anti-inflammatory and healing effect. For these purposes, Epigen Intim Spray is well suited. It helps relieve burning sensation, itching, inflammation and stimulates local immunity in the vagina.

Vaginal preparations for thrush

Topical antifungals are used to treat acute or recurrent uncomplicated candidiasis. They act directly on the infection locally in the affected area, i.e. on the skin and vaginal mucosa. The drugs are presented in several dosage forms:

• Vaginal tablets are convenient and have no systemic side effects. Intravaginal tablets act locally, preventing the growth of the fungus on the skin and vaginal mucosa.
• Vaginal suppositories – suppositories are suitable for the treatment of almost all types of VVC, except for severe ones, when a systemic effect is needed. It should be noted that candles based on oil components can violate the integrity of latex contraceptives (condoms and diaphragms).
• Creams and ointments are equally common forms of remedies for thrush.

Among local antimycotics in Russia, the following active substances are most often used:

• ketoconazole;
• natamycin;
• clotrimazole;
• miconazole;
• sertaconazole;
• nystatin;
• fenticonazole;
• econazole.

Vaginal antifungal agents for thrush successfully fight the pathogen, however, for the fastest possible relief of the patient’s condition in the acute phase of the disease, additional anti-inflammatory and healing therapy is necessary. At the same time, to prevent relapses, especially those caused by viral-bacterial associations, drug support for local immunity and antiviral treatment are recommended. Epigen Intim Spray has a complex effect in these areas due to the active ingredient of the drug – glycyrrhizic acid. The unique method of its activation, created by the developers of the drug, significantly enhances the therapeutic effects of the active substance:

• acceleration of the regeneration of damaged tissues;
• reduction of inflammation;
• increased local immunity;
• antiviral action – the fight against viral-fungal associations;
• elimination of itching, burning, dryness.

The drug accumulates in the lesions, while it penetrates into the systemic circulation slowly – the drug is found in the blood only in trace amounts. Can be used by pregnant women and during breastfeeding. The spray is equipped with nozzles for intravaginal and external use, which makes its use as convenient as possible.

When the body is weakened or exposed to factors that disrupt the normal microflora of the vagina, local antifungal drugs are prescribed as part of preventive measures. The preventive use of Epigen Intim spray will help to strengthen protection against recurrence of thrush. Its use is indicated when taking antibiotics, weakening the body after hypothermia, respiratory viral infections, stress, while traveling.

Treatment of recurrent VVC

Restoring the protective properties of the immune system is especially important in the diagnosed chronic course of candidiasis. One of the frequent causes of a decrease in local immunity and subsequent relapse of thrush is viral-fungal associations, therefore, in the treatment of recurrent candidiasis, it is important to prescribe antiviral therapy. Activated glycyrrhizic acid in the composition of the Epigen Intim spray actively fights viruses, including mutant strains against which classical antiviral drugs are ineffective.

In addition to the main treatment, after relief of acute symptoms, a woman is prescribed therapy aimed at preventing relapses. As part of the complex treatment, Epigen Intim Spray is prescribed for the following purposes:

• Quick relief from discomfort, reduction of inflammation and acceleration of regenerative processes during the acute phase of candidiasis.
• Treatment of viral-fungal associations and enhancement of local vaginal immunity to break the vicious cycle of VVC recurrences.
• Relief of the acute period takes an average of 7 days. Preventive therapy with various means can take up to 6 months.

Epigen Intim Spray

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Epigen Intim Spray

With candidiasis, hygiene procedures should be given special attention – careful intimate care helps maintain the natural microflora, which provides additional protection against recurrence of thrush. Epigen Intim gel is well suited for this purpose. This is a cosmetic cleanser for daily intimate hygiene. Its regular use maintains the normal pH level of the intimate area. Lactic acid, also included in the composition, helps maintain the natural balance of the vaginal microflora. Epigen Intimate gel has a pleasant aroma and provides a feeling of cleanliness throughout the day.

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Prophylaxis

Compliance with a number of preventive recommendations minimizes the risk of vulvovaginal candidiasis. The main preventive measures are listed below:

• Regular visits to specialists to compensate for chronic diseases that can increase the risk of developing candidiasis.
• Wear underwear made from natural fabrics and regularly change tampons and pads during menstruation, because the blood serves as a breeding ground for many pathogens.
• Avoid indiscriminate change of sexual partners, since in such a situation, even with protected contact, the risk of thrush significantly increases.
• All antibacterial drugs should be taken strictly according to the doctor’s prescription, as they inhibit the activity of other bacteria, and on the contrary, they provoke fungal growth.
• Don’t neglect your intimate hygiene by choosing pH-neutral care products. One of these reliable products is Epigen Intim Gel – it contains activated glycyrrhizic acid, obtained from licorice root, and lactic acid. This combination helps to maintain normal microflora, physiological pH of the intimate area and prevents the development of inflammation. For ease of use, Epigen Intim gel has a special dispenser, which also ensures economical consumption of the product. The gel bottle has a stable wide base to prevent accidental dropping.
• Wash from front to back during hygiene procedures to avoid the introduction of pathogens from the anal area.
• When using toilet paper, it is not recommended to roughly rub the crotch area, remove dirt with gentle blotting movements from front to back.