9 tips for treating vaginal thrush

What the guidelines say about recurrent vulvovaginal candidiasis

Recurrent candidiasis is generally regarded as a challenging infection.

thrush candida candidiasis

That's because none of the regimens are particularly effective and most women relapse following the prescribed therapy, say the authors of an Australian study.

“Despite most guidelines agreeing on six months of oral antifungals as the appropriate treatment, the results from this regimen are disappointing,” they write.

Large-scale studies are needed to identify more effective treatments.

In the meantime, here is a summary of current recommendations for treating vaginal thrush.

  • A woman has recurrent thrush when she has four or more episodes in a 12-month period.
  • Culture and wet microscopy are essential for a diagnosis of recurrent thrush.
  • Unless other diagnoses (STIs, bacterial vaginosis) are suspected, other tests are not required.
  • Asymptomatic colonisation does not require therapy.
  • Induction and maintenance therapy is the preferred treatment. Six months of weekly oral fluconazole is the most commonly recommended.
  • An alternative is a year-long regimen where oral fluconazole is gradually weaned from 200 mg three times a week during week one, once a week from weeks 2-8, once a fortnight from months 3-6 and once a month from months 7-12.
  • Topical therapy is recommended in pregnancy.
  • Diabetes and HIV should be excluded.
  • Partner treatment is not required.

Read the latest paper on the topic