Vaginal yeast infections (thrush): What helps?

Foto von Patientin in der Sprechstunde (PantherMedia / Monkeybusiness Images) Vaginal infections are often caused by an overgrowth of yeast (a type of fungus). Yeast infections in the vagina usually go away after a short course of treatment with antifungal medication. It’s not clear whether home remedies help.

Many women are familiar with the symptoms of vaginal yeast infections: unpleasant itching and burning, as well as whitish cottage-cheese-like vaginal discharge. Vaginal yeast infections are treated with antifungal drugs (antimycotics). The symptoms usually go away after a short course of treatment with these medications when used locally in the vagina.

It is sometimes a good idea to take oral medication (swallowed in the form of tablets) or to use a longer-term treatment.

How are antifungal drugs normally used?

Antifungal drugs kill or reduce the growth of fungi (including yeast). The following medications are often used to treat vaginal yeast infections:

  • Clotrimazole
  • Nystatin
  • Ciclopirox
  • Fluconazole

Fluconazole is only available as a tablet, and you need a prescription to get it. Most of the creams and vaginal suppositories are available from pharmacies without a prescription. In Germany and other countries you have to pay for them yourself, though.

Simple infections clear up after a few days of locally applied treatment (vaginal suppositories or creams). Depending on the drug used, the treatment takes one, three or six days. It's best to insert suppositories deep into the vagina before going to sleep. Most packages have an applicator in them, as well instructions, to help you insert the suppository. Creams also often come with an applicator to help you apply them inside the vagina. Vaginal suppositories sometimes come with a small tube of antifungal cream that you can apply to inflamed areas of the external (outer) genitals.

There is also a different treatment where you take (swallow) just one tablet. Doctors may recommend using that if you have your period, for instance.

If you keep getting vaginal yeast infections, your sex partner may have one in their genital area too – with similar symptoms, such as redness and itching at the tip of their penis or in their vagina. Then you might keep infecting each other. To prevent this kind of “ping pong effect,” it can be a good idea for your partner to see a doctor and use antifungal medication if necessary.

What are the risks associated with antifungal drugs?

Antifungal drugs that are applied to the skin or mucous membranes are generally well tolerated. The possible side effects include further irritation of the inflamed areas, burning and itching.

When using mechanical contraceptive devices, it's important to read the package insert carefully. Some antifungal drugs are oily. This can make contraceptives like condoms more porous, allowing sperm to pass through them.

If antifungal drugs are taken in the form of tablets that you swallow, they can lead to other side effects such as headaches, dizziness, nausea and diarrhea. There are also a lot of medications that shouldn't be used together with antifungal drugs because they may influence each other’s effect. These include certain allergy medicines, blood-pressure-lowering drugs and medications for psychological problems. You can find out about these “drug-drug interactions” in the package insert that comes with the antifungal drug.

Antifungal drugs that you swallow (oral antifungals) haven’t been approved for use in women who are pregnant or breastfeeding. But those that are used locally in the vagina (creams and suppositories) can be used by this group of women.

When is a longer-term treatment considered?

If you have a complicated vaginal yeast infection, it’s a good idea to talk to your doctor. He or she may recommend using a treatment over a longer period of time. A vaginal yeast infection is considered to be “complicated” if it causes more severe symptoms such as widespread, painful swelling in the vagina and on the outer genitals – or if the infection recurs more than four times per year. Yeast infections are also considered to be complicated if they’re caused by a weakened immune system, for instance due to an HIV infection.

When treating complicated vaginal yeast infections, an initial treatment is typically followed by maintenance treatment. In the initial phase of treatment,

  • creams or suppositories are used for 1 to 2 weeks, or
  • instead, one oral tablet is taken every three days for about a week.

This is usually followed by maintenance treatment, where you take one antifungal tablet per week over a period of six months. If you can’t take tablets – for instance, due to a pregnancy or interactions with other drugs – you can use only creams or suppositories for the whole treatment period.

Are there effective alternatives to antifungals?

The membranes lining a healthy vagina contain a lot of lactic acid bacteria. These bacteria are a normal part of the vaginal flora – the natural balance of microorganisms (germs) there. Small amounts of yeast are also normal. If this natural balance is upset, harmful bacteria or yeast can thrive and lead to an inflammation.

There are vaginal suppositories or capsules that contain live lactic acid bacteria (probiotics). These products are designed to protect and restore the natural balance in the vagina. They may help to fight a yeast infection when used in addition to antifungal drugs. But it’s not clear whether they can effectively fight a yeast infection when used on their own.

Some women use home remedies to treat vaginal yeast infections. For instance, they may eat garlic or natural yogurt. Others insert garlic cloves into their vagina, or use tampons soaked in things like tea tree oil or natural yogurt. But there’s hardly any research on whether these kinds of home remedies can help to get rid of vaginal yeast infections or prevent them. They are, however, associated with risks such as allergic reactions or irritated mucous membranes. Vaginal douches or female intimate hygiene products may irritate the skin, making the inflammation worse.