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Yeast Infection OTC Cream: Complete Guide to Miconazole Nitrate Vaginal Treatment

by alexxlab

What are the most effective over-the-counter treatments for vaginal yeast infections. How does miconazole nitrate cream work to relieve symptoms. What are the potential side effects and precautions when using OTC antifungal creams.

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Understanding Vaginal Yeast Infections and Their Causes

Vaginal yeast infections, medically known as vulvovaginal candidiasis, are incredibly common, affecting up to 75% of women at least once in their lifetime. But what exactly causes these uncomfortable infections?

Yeast infections occur when there’s an overgrowth of Candida, a type of fungus naturally present in the vagina. Under normal circumstances, the vagina maintains a delicate balance of yeast and bacteria. However, certain factors can disrupt this balance, leading to an overgrowth of yeast.

  • Antibiotic use
  • Hormonal changes (pregnancy, menstruation, or hormone therapy)
  • Weakened immune system
  • Uncontrolled diabetes
  • Tight, non-breathable clothing
  • Douching or using scented feminine products

Can stress cause yeast infections? While stress itself doesn’t directly cause yeast infections, it can weaken your immune system, making you more susceptible to infections, including those caused by yeast overgrowth.

Recognizing the Symptoms of a Vaginal Yeast Infection

Identifying a yeast infection early can help you seek treatment promptly and avoid unnecessary discomfort. The most common symptoms include:

  • Intense itching and irritation in the vagina and vulva
  • Burning sensation, especially during urination or intercourse
  • Redness and swelling of the vulva
  • Vaginal pain and soreness
  • Thick, white, odorless discharge with a cottage cheese-like appearance
  • Watery vaginal discharge

Are all vaginal discharges a sign of yeast infection? Not necessarily. While vaginal discharge is a common symptom, other conditions like bacterial vaginosis or sexually transmitted infections can also cause changes in discharge. It’s important to consult a healthcare provider for an accurate diagnosis.

Over-the-Counter Treatment Options for Yeast Infections

Fortunately, many effective over-the-counter (OTC) treatments are available for vaginal yeast infections. These typically come in the form of antifungal creams, suppositories, or tablets. The most common active ingredients in OTC yeast infection treatments include:

  1. Miconazole (e.g., Monistat)
  2. Clotrimazole (e.g., Canesten)
  3. Tioconazole (e.g., Vagistat-1)

These medications work by killing the excess yeast and relieving symptoms. They are available in various treatment durations, ranging from single-dose treatments to 7-day regimens.

Is a longer treatment duration more effective? Not necessarily. While longer treatments may be suitable for more severe infections, many women find relief with shorter courses. The choice often depends on personal preference and the severity of symptoms.

Miconazole Nitrate: A Closer Look at This Popular Antifungal

Miconazole nitrate is one of the most widely used antifungal medications for treating vaginal yeast infections. It belongs to a class of drugs called azole antifungals and works by preventing the growth of yeast.

How does miconazole nitrate work? This medication interferes with the production of ergosterol, a crucial component of fungal cell membranes. By disrupting the cell membrane, miconazole effectively kills the yeast and stops its growth.

Miconazole nitrate is available in several forms:

  • Vaginal creams
  • Vaginal suppositories
  • Combination packs (containing both internal and external treatments)

The choice between cream and suppository often comes down to personal preference. Some women find creams easier to apply, while others prefer the convenience of suppositories.

Proper Application and Use of Miconazole Nitrate Vaginal Cream

Using miconazole nitrate correctly is crucial for its effectiveness. Here’s a step-by-step guide on how to apply the vaginal cream:

  1. Wash your hands thoroughly before and after application.
  2. Fill the applicator with the cream as directed in the product instructions.
  3. Gently insert the applicator into the vagina as far as it comfortably goes.
  4. Slowly press the plunger to release the cream.
  5. Remove the applicator and dispose of it if it’s meant for single use, or clean it as directed if it’s reusable.

When is the best time to apply miconazole nitrate cream? Many women find it most convenient to use the cream at bedtime, as lying down can help reduce leakage. However, follow the specific instructions provided with your product.

It’s important to complete the full course of treatment, even if symptoms improve before you’ve finished. This helps ensure that the infection is fully cleared.

Potential Side Effects and Precautions of Miconazole Nitrate

While miconazole nitrate is generally safe and effective, like all medications, it can cause side effects in some people. Common side effects may include:

  • Headache
  • Mild burning or irritation
  • Lower abdominal cramps
  • Nausea

Do these side effects mean the treatment isn’t working? Not necessarily. Many women experience mild side effects that resolve on their own. However, if you experience severe or persistent side effects, it’s important to consult your healthcare provider.

Precautions to keep in mind when using miconazole nitrate:

  • Avoid using tampons, douches, or spermicides during treatment
  • Refrain from sexual intercourse or use condoms to prevent spreading the infection
  • If you’re pregnant or breastfeeding, consult your doctor before using any OTC treatments
  • If you have recurring yeast infections (4 or more in a year), seek medical advice

When to See a Doctor for a Yeast Infection

While OTC treatments are effective for many women, there are situations where it’s important to consult a healthcare provider:

  • If it’s your first yeast infection
  • If symptoms don’t improve after completing OTC treatment
  • If you have recurring yeast infections
  • If you’re pregnant
  • If you have diabetes or a weakened immune system
  • If you’re not sure whether your symptoms are caused by a yeast infection

Can untreated yeast infections lead to more serious problems? While yeast infections are generally not dangerous, leaving them untreated can lead to increased discomfort and potentially spread the infection. In rare cases, the infection can enter the bloodstream, a condition called invasive candidiasis, which can be serious.

Preventive Measures to Reduce the Risk of Yeast Infections

While it’s not always possible to prevent yeast infections entirely, certain lifestyle changes can help reduce your risk:

  • Wear breathable, cotton underwear
  • Avoid tight-fitting pants or pantyhose
  • Change out of wet swimsuits or workout clothes promptly
  • Avoid douching or using scented feminine hygiene products
  • Wipe from front to back after using the bathroom
  • Maintain good blood sugar control if you have diabetes
  • Consider taking probiotics, especially when on antibiotics

Is diet linked to yeast infections? While there’s no definitive evidence, some studies suggest that a diet high in sugar and refined carbohydrates may contribute to yeast overgrowth. Maintaining a balanced diet rich in fruits, vegetables, and whole grains may help support overall vaginal health.

By understanding the causes, symptoms, and treatment options for yeast infections, you can take proactive steps to maintain your vaginal health. Remember, while OTC treatments like miconazole nitrate can be effective, it’s always best to consult with a healthcare provider if you’re unsure about your symptoms or if they persist despite treatment.

Yeast Infection Cream | Walgreens

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  • Walgreens Clotrimazole Vaginal Cream (1.5 oz )Walgreens

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  • Walgreens Tioconazole Ointment 6.5 Percent, 1-Dose Treatment for Vaginal Yeast Infection (0.16 oz )Walgreens

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Yeast Infection Cream

Yeast infections can be a bothersome and uncomfortable experience, and they can affect anyone. While yeast infections can occur in different parts of the body, including the mouth, nail beds and moist areas of skin, vaginal yeast infections are very common, affecting nearly 3 out of 4 women in their lifetimes. There are a variety of over-the-counter products available to ease the symptoms associated with vaginal yeast infections and help prevent the infection from getting worse. These include antifungal creams and suppositories in various doses and quantities. All of these varieties of yeast infection treatments can be purchased in stores or online at Walgreens.

What is a yeast infection?

A yeast infection (candidiasis) is an overgrowth of a certain type of fungus called Candida that is normally harmless and found on the body. However, some environmental and health conditions can cause this yeast to overpopulate and bring about bothersome symptoms. Yeast infections can occur on the skin and the mucous membranes, which can include the mouth, digestive tract, vagina, armpits, breasts and other sites that may retain moisture.

Vaginal yeast infections can happen to anyone. However, pregnancy, antibiotics and diabetes may put certain women more at risk for developing them. Wearing non-breathable clothing such as synthetic fabric underwear may also contribute to yeast growth. Luckily, there are products and medications available at Walgreens in stores and online that may help you find relief from a yeast infection.

What are the common symptoms of a yeast infection?

Vaginal yeast infections are quite unpleasant, and symptoms can get more intense with time. Some of the common symptoms may include:

  • Burning sensation, especially during sexual intercourse or urination

  • Itching, swelling, and redness in and around the vagina

  • Watery, white or yellow cheese-like discharge from the vagina

  • Vaginal soreness or pain

Many of these symptoms can mimic other infections or health conditions so it’s important that you contact your healthcare provider if you’re experiencing these symptoms. Some yeast infections can become worse or require additional treatment.

How does yeast infection cream work?

Yeast infection creams are intended to alleviate symptoms and reduce the population of fungus. There are multiple treatment options for vaginal yeast infections, including medicated suppositories and creams as well as homeopathic remedies.

Some over-the-counter vaginal yeast infection products and creams may help relieve symptoms or get rid of the infection with just a single dose. Some of the more common antifungal ingredients in yeast infection creams may include miconazole, clotrimazole, or tioconazole. If you use a yeast infection cream and continue to have symptoms, tell your healthcare provider.

How to use yeast infection cream

Different vaginal yeast infection creams may be intended to be used for different periods of time. You should follow all product instructions carefully and use as directed. Over-the-counter vaginal yeast infection treatment products will usually come with an applicator that is used to insert the cream or suppository into the vagina. Most creams or antifungal capsules are inserted into the vagina at bedtime for one or more days, depending on the product. If you have any questions about yeast infection creams, ask your Walgreens pharmacist in store or online in Pharmacy Chat.

6 Best Yeast Infection Treatments 2023

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Medical News Today only shows you brands and products that we stand behind.

Our team thoroughly researches and evaluates the recommendations we make on our site. To establish that the product manufacturers addressed safety and efficacy standards, we:

  • Evaluate ingredients and composition: Do they have the potential to cause harm?
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We do the research so you can find trusted products for your health and wellness.

Read more about our vetting process.

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Yeast infection treatments may include pills or topical medications with over-the-counter (OTC) and prescription options available. Several places sell OTC or prescription treatments online.

  • Best range of treatments: Monistat | Skip to review
  • Best pill: Fluconazole | Skip to review
  • For rapid treatment: FemiClear Yeast Infection 2-Day Treatment | Skip to review
  • Best preventive treatment: Uqora Promote | Skip to review
  • Best preventive suppository: Love Wellness The Killer | Skip to review
  • Best budget treatment: CVS Health Miconazole 7-Day Vaginal Treatment | Skip to review

Please note that the writer of this article has not tried these products. All information presented is purely research-based and correct at the time of publication.

Medical News Today follows a strict product selection and vetting process. Learn more here.

Best range of treatments: Monistat

  • List price: around $14 for a pack of three applicators
  • Active ingredients: miconazole nitrate
  • Treatment time: 1, 3, or 7 days
  • Supply: 1, 3, or 7 prefilled applicators

Monistat is available in several pharmacies and retail stores, including Walmart, throughout the United States. It provides treatment options that include 1, 3, and 7 days’ worth of doses.

This product comes in the form of internal suppositories and external creams with applicators that help people place the yeast infection treatment in the right area. Some packs include additional topical itch medications to help ease symptoms.

Each applicator contains 200 milligrams (mg) of miconazole nitrate, a medication that treats fungal infections.

This product is most suited to individuals who currently have a yeast infection and would like to try multiple methods to treat it.

Read our review of Monistat here.

SHOP NOW AT WALMART

Pros

  • readily available in retail stores
  • various treatment options available in one pack
  • FSA- and HSA-eligible
  • affordable price

Cons

  • reviews mention burning, stinging, or itching sensations
  • may cause heavy discharge

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Best pill: Fluconazole

  • List price: $15 quarterly fee or a $65 one-time fee
  • Active ingredients: generic fluconazole
  • Treatment time: 2 days
  • Supply: up to 2 pills

Fluconazole is a generic version of the prescription pill Diflucan, which people can take to treat yeast infections.

Individuals need to take a single pill first. If symptoms do not improve after 2 days, they can take a second pill.

Online pharmacies, such as Wisp, offer quick delivery of fluconazole. They can also provide same-day or rushed prescriptions to a person’s local pharmacy.

Read our review of Wisp here.

Wisp offers subscriptions for those who regularly have yeast infections and accepts FSA and HSA cards as payment.

This product may be most suitable for individuals who regularly experience yeast infections or when creams have not worked.

SHOP NOW AT WISP

Pros

  • available for same-day pick up from a local pharmacy
  • FSA- and HSA-eligible
  • subscription service available

Cons

  • one-time purchases are expensive
  • Wisp does not accept insurance

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Best rapid treatment: FemiClear Yeast Infection 2-Day Treatment

  • List price: around $20
  • Active ingredients: olive oil, melaleuca, calendula, and lavender essential oil
  • Treatment time: 2 days
  • Supply: two suppositories

FemiClear’s 2-day yeast infection treatment includes two suppositories that a person inserts into their vagina and an external anti-itch ointment for symptom relief.

The product contains calendula, tea tree oil, olive extract, beeswax, and olive oil to combat itching and discomfort.

The company recommends using this yeast infection treatment before bed or wearing a panty liner to ensure that it does not leak.

The FDA classes this product as an unapproved homeopathic treatment and states it has not tested it for safety or efficacy. The FDA writes that it is not aware of scientific research that supports the effectiveness of homeopathic remedies.

This may best suit individuals who currently have a yeast infection and prefer to use organic ingredients. However, it is unsuitable for vegans because it contains beeswax.

Read our review of Femiclear here.

SHOP NOW AT WALMART

Pros

  • organic ingredients
  • affordable price
  • treatment lasts 2 days

Cons

  • unsuitable for vegans
  • does not have FDA approval
  • suppository may not suit some people

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Best preventive treatment: Uqora Promote

  • List price: around $30
  • Active ingredients: L. acidophilus, L. rhamnosus, and L. reuteri
  • Treatment time: ongoing preventive treatment
  • Supply: 30-day supply

The makers of Uqora Promote say the product promotes vaginal health rather than specifically targeting yeast infections.

It contains Lactobacillus acidophilus (L. acidophilus), Lactobacillus rhamnosus (L. rhamnosus), and Lactobacillus reuteri, which the company claims can help balance vaginal bacteria.

Some research suggests that Lactobacilli such as L. acidophilus and L. rhamnosus show promise in preventing vaginal infections.

The company recommends taking this supplement daily with a glass of water.

Uqora Promote may be suitable for people who regularly get yeast infections as a preventive treatment. It is vegan-friendly and gluten-free, meaning it may also suit people following certain diets.

Read our review of Uqora here.

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Pros

  • useful as a preventive treatment
  • suitable for vegans
  • gluten-free
  • free shipping
  • subscription is possible, making it cheaper by 15%

Cons

  • targets vaginal health instead of treating yeast infections specifically
  • higher cost than other options
  • does not have Food and Drug Administration (FDA) approval

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Best preventive suppository: Love Wellness The Killer

  • List price: around $22
  • Active ingredients: boric acid
  • Treatment time: ongoing preventive treatment
  • Supply: up to 14 days of use

The Killer by Love Wellness aims to prevent yeast infections from developing and claims to keep vaginal bacteria healthy.

The capsule contains boric acid, which may be effective in treating recurrent yeast infections that have not responded to to anti-fungal treatments.

Learn more about using boric acid to treat yeast infections here.

The brand recommends inserting this vaginal suppository once a day before bed for up to 14 days, as needed. The brand also recommends that the best times to use The Killer might be after sex, after a period, or when a person is experiencing symptoms of a pH imbalance.

The FDA classes this product as an unapproved homeopathic treatment and states it has not tested it for safety or efficacy. The FDA writes that it is not aware of scientific research that supports the effectiveness of homeopathic remedies.

The Killer is suitable for anyone who may be prone to vaginal yeast infections. Love Wellness does not recommend a person to have sexual intercourse while using this product.

SHOP NOW AT LOVE WELLNESS

Pros

  • affordable price
  • subscription service is possible, saving 25%
  • gluten- and dairy-free
  • not tested for safety or efficacy

Cons

  • a person cannot have sexual intercourse during the treatment
  • shipping is not free unless customers spend over $35
  • unsuitable for vegans

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Best budget option: CVS Health Miconazole 7-Day Treatment

  • List price: around $8
  • Active ingredients: miconazole nitrate
  • Treatment time: 7 days
  • Supply: seven prefilled applicators

This CVS Health treatment comes with seven doses of disposable internal applicators and external cream.

Each applicator contains 100 mg of miconazole nitrate. The manufacturer recommends that people insert an applicator before going to bed. Individuals should dispose of the applicator immediately after use.

The treatment is available both in-store and online. It may best suit individuals who would prefer a product that works while they sleep. However, a person should not use this if they have not received a diagnosis of a yeast infection from a doctor.

SHOP NOW AT CVS

Pros

  • affordable price
  • uses both internal applicators and external cream
  • available to purchase in-store and online
  • works while a person sleeps

Cons

  • may cause burning and itching sensations
  • a person cannot use tampons while using this product
  • takes longer than other treatment options
  • users cannot have sex while using this product

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The table below compares each of the products for price, ingredients, and more.

List priceActive ingredientsTreatment timeSupply
Monistataround $14miconazole nitrate1—7 days1—7 prefilled applicators
Generic
Fluconazole		around $15–$65generic fluconazole2 daysup to 2 pills
FemiCleararound $20• olive oil
• melaleuca
• calendula
• lavender essential oil		2 daystwo suppositories
Uquoraaround $30• L. acidophilus
• L. rhamnosus
• L. reuteri		ongoing preventive treatment30 days
Love Wellnessaround $22boric acidongoing preventive treatmentup to 14 days
CVS Healtharound $8miconazole nitrate7 days7 prefilled applicators

Doctors typically recommend OTC antifungal medications to treat a vaginal yeast infection.

Antifungal medications come in a variety of forms, including:

  • creams
  • tablets
  • ointments
  • vaginal suppositories

Treatments may come as one single dose or a daily dose over several days. A person should read the dosing instructions carefully to ensure they use the correct dosage.

Some of the products in this article are classed as homeopathic treatments.

There are no FDA-approved homeopathic products. This means that any product sold in the U.S. and marketed as homeopathic is not FDA-approved and the FDA has not tested it for safety or effectiveness.

MNT chose yeast infection treatments that meet the following criteria:

  • Reputable brands: Our medical and business teams have thoroughly researched all brands in this article to ensure their safety and reputability. This means the brands we chose do not make unsupported health claims and their products do not contain unsafe ingredients.
  • Accessibility: MNT chose brands that are widely available in-store, online, and over the counter.
  • Cost: MNT selected nonprescription items with some of the most budget-friendly price points. For prescription products, MNT ensured multiple payment options, including health savings accounts (HSAs) and flexible savings accounts (FSAs).
  • Treatment times: MNT chose products that claim to treat yeast infection symptoms in as few days as possible.
  • Treatment type: MNT chose products that have a range of treatment types, such as pills, probiotics, and suppositories.

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Yeast infections occur due to an overgrowth of Candida. This is a type of fungus that normally lives in areas of the body such as the vagina and mouth.

According to the Office on Women’s Health (OWH), most females will experience a vaginal yeast infection at some point in their life.

The Centers for Disease Control and Prevention (CDC) explain that some common symptoms of a vaginal yeast infection include:

  • pain during sexual intercourse
  • itchiness or soreness around the vagina
  • unusual discharge from the vagina
  • discomfort or pain during urination

The CDC adds that risk factors for developing an overgrowth of Candida include:

  • using hormonal birth control
  • being pregnant
  • recent antibiotic use
  • having a weakened immune system
  • having diabetes

The OWH points out that a yeast infection may develop due to sexual intercourse. However, doctors do not classify this as a sexually transmitted infection (STI).

Since yeast infection symptoms are similar to those of other infections and conditions, such as contact dermatitis, a person should contact a doctor before taking any OTC medications. The doctor can test for yeast or other infections to provide the appropriate treatment.

People can take some steps to help prevent yeast infections. For example, they can try:

  • avoiding irritating soaps
  • not using vaginal douches
  • regularly changing tampons and sanitary napkins
  • keeping the outer genital area dry and clean
  • not using panty liners every day
  • avoiding scented products for use around the vagina
  • only using antibiotics when a doctor prescribes them
  • wiping from the front to the back after using the toilet
  • changing into dry clothes immediately after swimming
  • wearing loose-fitting cotton underwear
  • maintaining a stable blood sugar level

Learn more about preventing yeast infections here.

People should be aware of the following advice when taking medication for yeast infections:

  • Dosage: It is important to take the entire course of medication to clear an infection. For example, with a 7-day suppository, a person should insert suppositories daily for the full 7 days, even if symptoms begin to clear before the 7-day period ends.
  • Birth control: The oils in certain suppositories and creams can interfere with barrier birth control methods. They can weaken the materials in condoms, making them less effective. When using these yeast infection treatments, a person should use a different form of birth control or abstain from sex during the duration of the treatment if they would typically use a condom.
  • Pregnancy: Pregnant people should always consult a doctor before using any prescription or nonprescription medication to treat an infection.

Before starting treatment, individuals should contact a doctor for a diagnosis. Knowing exactly which infection they have ensures that the person uses the appropriate treatment and does not create fungus resistant to future treatments.

A person should contact a doctor if they suspect that they have a yeast infection, as symptoms can be similar to those of other conditions. The doctor can properly diagnose and treat a yeast infection.

If a yeast infection does not clear up with treatment, the person should seek further medical advice. They may need to adjust their medications to treat any itching and discomfort.

Recurring yeast infections

According to the OWH, yeast infections are usually mild. They cause symptoms such as itchiness, pain, and unusual discharge. Most females will develop a yeast infection at some point in their life.

The OWH also says that some people develop recurring yeast infections.

Risk factors for recurring yeast infections, or recurrent vulvovaginal candidiasis (RVVC), include having diabetes or a compromised immune system.

However, individuals can develop recurring yeast infections even if they do not have any risk factors.

If a person experiences RVVC, a doctor will likely recommend or prescribe antifungal medications for up to 6 months to help keep the fungus under control.

Below are answers to some common questions about treating yeast infections.

How quickly do yeast infection treatments work?

Preventive yeast infection treatments have varying time frames, but many come in 30-day supplies. Pill, cream, and suppository yeast infection treatments usually come as 1-, 2-, 3-, 7-, or 14-day treatments.

What is the fastest way to get rid of a yeast infection?

Treatment times can vary from person to person, but anecdotal reports suggest a single fluconazole dose can clear up a yeast infection in just a few hours.

Do people need a prescription for these treatments?

Most yeast infection suppositories and preventive probiotics are available as OTC treatments. However, yeast infection pills such as fluconazole are only available through prescription.

Is one yeast infection pill enough?

Depending on the severity of the infection, type of pill, and dosage, a single tablet may be enough to clear a yeast infection. Individuals should always let their doctor guide their treatment and discuss ongoing symptoms with them.

Can I get a yeast infection from sex?

Although penetrative sex cannot directly cause a yeast infection, a person may develop a yeast infection after sex if they engage in oral sex or insert fingers or toys into the vagina.

This is because these activities may introduce bacteria into or around the vagina.

Learn more about yeast infections after sex.

Can a person pass on a yeast infection?

Yeast infections are not STIs. However, it is possible for yeast infections to transmit from one person to another following sexual intercourse.

Females can pass on yeast infections to males, but this is uncommon and may affect just 15% of males.

Do yeast infection pills have side effects?

Pills for yeast infections, such as fluconazole, may have some side effects.

Common side effects include nausea, diarrhea, headache, stomach pain, and a rash.

Yeast infections are often mild, and a person can typically treat them using OTC medications. Medications come in different forms and doses, so it is important to follow the instructions on the package.

A person should not self-diagnose a yeast infection, as many of the symptoms are similar to those of other illnesses and conditions.

Once a doctor diagnoses this infection and a person treats it, they should notice symptom improvement.

Remedies for thrush: tablets, suppositories, ointments

Where can I buy?

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, corticosteroids, 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:

  • Drugs of the azole group
  • 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 the external treatment of mycoses 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
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  20. Ogneshchenko NA Vulvovaginal candidiasis: what’s new? Published online 2012:70-72
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Thrush in women: symptoms and treatment

Thrush (vaginal candidiasis) is an infectious disease caused by the active reproduction of yeast-like fungi of the genus Candida on the mucous membranes of the female genital organs.

Along with bacterial infections (bacterial vaginosis), thrush is one of the most common diseases in women, most often occurs in reproductive age, less often in postmenopausal women (in the absence of hormone replacement therapy with estrogen), and even less often in girls before the onset of the first menstruation.

The highest risk of vaginal candidiasis occurs during pregnancy, other risk factors include a weakened immune system and the use of certain medications.

Causes

The most common type of fungus that causes yeast infections is Candida albicans, which is an opportunistic pathogen. Infections caused by other types of Candida are much less common and more difficult to treat. Candida albicans is present in the gastrointestinal tract, in the mouth, vagina, and on the skin. When their number increases, a yeast infection develops, which can affect any of the organs listed.

Risk factors for developing vaginal candidiasis include: taking antibacterial drugs, hormonal changes (during pregnancy), hormonal contraceptives (birth control pills, patches) and other contraceptives (vaginal diaphragm, vaginal ring, intrauterine device), diabetes mellitus, overweight, reduced immunity (due to HIV, immunosuppressive drugs, steroids, chemotherapy drugs), high sexual activity .

Fungal infection is not sexually transmitted, but candidiasis can develop in men after intimacy with a woman with vaginal candidiasis.

Symptoms

Symptoms of thrush include:

  • unusual vaginal discharge (watery or white cheesy), odorless;
  • itching and burning in the vagina and vulva;
  • swelling and redness of the mucous membrane of the vagina and external genitalia;
  • pain during intercourse;
  • soreness and burning when urinating.

These symptoms are similar to those of other conditions – bacterial vaginosis, trichomoniasis, dermatitis, so it is required to determine what specifically caused them. If they appear for the first time, do not disappear after using over-the-counter remedies for the treatment of thrush, be sure to consult a gynecologist. Important: self-diagnosis and treatment of thrush with over-the-counter drugs is not the most correct tactic. There is always a risk of additional financial burden, improper treatment and side effects caused by it. Only a doctor can determine exactly what is causing your condition.

Diagnosis

Your doctor will ask you about your symptoms, medical conditions, medications you are taking, perform a gynecological exam, take a vaginal swab for microscopic examination.

Treatment of thrush

Treatment of thrush is with antifungal drugs and depends on the severity and frequency of the infection. The doctor may prescribe the antifungal drug miconazole or tecnazole (tablets, suppositories, creams, ointments) for 3 to 7 days if symptoms are mild or moderate, or fluconazole (Diflucan) once (for more severe symptoms, two doses 3 days apart). During pregnancy, oral forms of drugs are not recommended.

For recurrent vaginal candidiasis (4 or more infections per year), long-term antifungals are prescribed.

There is no evidence that probiotics and yogurts containing live lactobacilli improve the condition of women with recurrent vaginal candidiasis.

Benefits of treating thrush at Rassvet Clinic

Gynecologists at Rassvet Clinic have extensive practical experience and extensive knowledge necessary for the diagnosis and treatment of vaginal candidiasis.

We employ caring and delicate specialists who will definitely help you get rid of an unpleasant problem. Diagnosis and treatment of thrush in the Rassvet clinic is carried out according to the most modern standards, using international clinical recommendations.

References
  • Jack D Sobel, MD, UpToDate: Patient education: Vaginal yeast infection (Beyond the Basics) // Last updated: Jan 25, 2021/ https://www. uptodate.com/contents/vaginal-yeast-infection-beyond-the-basics
  • MedlinePlus, National Library of Medicine: Vaginal yeast infection // Review Date 30/6/2019 / https://medlineplus.gov/ency/article/001511.htm
  • Mayo Foundation for Medical Education and Research: Yeast infection (vaginal) // https://www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999
  • Johns Hopkins Medicine: Yeast infection // https://www.hopkinsmedicine.org/health/conditions-and-diseases/candidiasis-yeast-infection
  • Oluwatosin Goje, MD, MSCR, Cleveland Clinic, MSD Manual: Vaginal Yeast Infection (Candidiasis) // Last full review/revision Apr 2021 / https://www.msdmanuals.com/home/women-s-health-issues/vaginal-infections-and-pelvic-inflammatory-disease/vaginal-yeast-infection-candidiasis 900 60
  • Centers for Disease Control and Prevention (CDC): Vaginal Candidiasis // Last reviewed: October 12, 2021 / https://www.