Vaginal yeast infections (thrush): What can help?

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 is best to insert suppositories and creams deep into the vagina before going to sleep. To help you do this, most packages have an applicator and instructions in them. Vaginal suppositories sometimes come with a small tube of antifungal cream that you can apply to affected 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. Research has shown that medications like fluconazole tablets work somewhat better than creams or vaginal suppositories do. But all of the treatments are equally good at relieving symptoms such as itching or burning.

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 too and use antifungal medication if necessary.

Antifungal drugs that are applied to the skin or mucous membranes are generally well tolerated. The possible side effects include further irritation of the affected 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.

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 continue treatment with locally applied antifungal cream or suppositories.

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 infection.

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 can cause things like allergies or irritate the mucous membranes, though. Vaginal douches or female intimate hygiene products may irritate the skin, making the symptoms worse.