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If you have a vagina, chances are you’ve heard of yeast infections — or even had one. Up to 75% of women will get a yeast infection at least once, making them an extremely common condition.
Although they’re almost a universal experience for women and people with vaginas, the treatment options for yeast infections aren’t always one-size-fits-all.
Keep reading to learn more about what causes a yeast infection, how to spot the signs, and more importantly, the most common treatment options for getting rid of one.
What causes yeast infections?
Yeast infections are caused by Candida, a fungus that lives on our skin and in other areas of the body, including the mouth, throat, and vagina. Though Candida can present in the vaginal microbiome of healthy people, sometimes it overgrows and triggers unpleasant symptoms such as cottage cheese-like discharge and itching.
Up to 90% of yeast infections are caused by a type of Candida called Candida albicans (C. albicans), but other strains can overgrow, too. These include Candida glabrata (C. glabrata), C. tropicalis, C. parapsilosis, and C. krusei, among others. The type of strain is important because it will determine what’s the best treatment option for you.
How to treat a yeast infection
Vaginal yeast infections can be anything from rare and harmless to chronic and severe. But given how common they are, it’s important to understand how to treat them — especially since they have a nasty habit of resisting treatment or showing up again.
Before we get into specific treatment options for yeast infections, we’ll stress once again the importance of testing and getting a diagnosis before pursuing any treatment (even something as innocuous as a drug-store remedy). In order to get the best, most effective treatment for whatever is happening in your vaginal microbiome, you and your healthcare provider need to have an understanding of what’s happening microbially in your vagina.
This is where an Evvy test can be helpful. We've created the first-ever platform for vaginal healthcare that combines state-of-the-art vaginal microbiome testing, prescription treatment, and 1:1 coaching to get you the answers, relief, and support that you deserve. Built with leading OB-GYNs and researchers, Evvy's care platform can connect you to providers trained to review your vaginal microbiome results and select the best antifungal to decrease your specific strains of Candida (including ones that aren't often tested for at the doctor's office.) They'll also recommend research-backed supplements to build back your microbiome to a protective state.
Okay, back to Candida.
Because yeast infections are caused by a fungus, the first line of treatment will be a type of antifungal medication. Yeast infection treatment can be bought over-the-counter (OTC) or with a prescription and can come in the form of creams or oral medications.
The dosage, length, and efficacy of treatment will also depend on what strain is causing the yeast infection, how bad your symptoms are, and your overall health. This means your doctor might recommend different types of treatment, like a longer or stronger dose, or to take different treatments together.
Antifungals are designed to kill yeast, but sometimes they can also kill other bacteria — including healthy ones. Unfortunately, very few studies have looked into how antifungals impact the vaginal microbiome, so very little is known about their effects on the good bacteria that might live there.
Prescription vs Over-the-Counter Treatments for Yeast Infections
Over-the-counter treatments for yeast infections
Clotrimazole
Brand names: Gyne-Lotrimin, Mycelex
Type of medication: Antifungal agent
Administration route: intravaginal (cream applied vaginally)
Clotrimazole is an antifungal used to treat yeast infections throughout the body. Fun fact: it’s also used to treat the yeast that causes athlete's foot.
You can buy clotrimazole under many different brand names, but most of them come in the form of a cream with a vaginal applicator. The CDC recommends using either 5g of 1% cream intravaginally for 7-14 days, or 5g of the 2% cream for 3 days.
It’s also recommended to avoid penetrative vaginal sex when using clotrimazole as it may interfere with spermicides and the stability of condoms — but then again, you’re probably not going to be in the mood for sex if you’re dealing with the gnarly symptoms of yeast infection.
It’s unclear whether clotrimazole can be harmful to the vaginal microbiome, but some studies show that the drug is formulated with Lactobacillus probiotics, so we can assume that it doesn’t hurt lactobacilli levels in your vaginal microbiome.
Miconazole
Brand name: Monistat, Vagistat, and others
Type of medication: Antifungal agent
Administration route: intravaginal (cream or suppository applied vaginally)
Miconazole — or Monistat, as most of us know it — is another antifungal that has been used for quite a long time (it was FDA approved in the 1970s). Similarly to clotrimazole, it’s also used to treat other fungal infections like ringworm, athlete's foot, and jock itch.
Miconazole can come as either a cream or a suppository. The CDC recommends using any of the following vaginal preparations:
- 5g of 2% cream for 7 days
- 5g of 4% cream for 3 days
- 100mg suppository daily for 7 days
- 200mg suppository daily for 3 days
- 1,200mg suppository for 1 day
Tioconazole
Brand name: Trosyd, Gyno-trosyd
Type of medication: Antifungal agent
Administration route: intravaginal (cream applied internally)
Tioconazole is also used to treat fungal infections throughout the body (like ringworm, athlete’s foot, and jock itch). For treating yeast infections, it comes as an ointment that is applied vaginally. The CDC recommends using 5g of 6.5% ointment intravaginally for 1 day.
In an older study from the 1990s, tioconazole was found to be moderately effective at killing BV-associated bacteria Gardnerella, Mobiluncus, and Prevotella, while Lactobacillus species were resistant. Although more research is needed, it seems as though tioconazole isn’t harmful to the vaginal microbiome.
Boric acid
*Note: Technically, boric acid is available over the counter which is why it’s in this section. But, you should try to get your boric acid prescribed by a healthcare provider as it tends to be more pure and less likely to cause adverse reactions than boric acid sold OTC or online through a site like Amazon.
Boric acid is an alternative therapy that has become more and more popular for treating vaginal infections in recent years. It’s a white powder made from borax, a naturally occurring mineral that is composed of the elements boron, hydrogen, and oxygen.
It has antimicrobial and antifungal properties and existing research suggests it’s quite good at treating yeast infections, especially when antifungals have failed, or a yeast infection keeps coming back.
Research suggests that boric acid is as effective as traditional antifungal medications in treating yeast infections. In some cases, it may be more effective than standard first-line treatment, especially when an atypical Candida species is at play.
The CDC guidelines recommend 600 mg of boric acid in a gelatin capsule administered vaginally once daily for 3 weeks for recurrent non-albicans yeast infections. However, there needs to be more research on the effectiveness of boric acid on all types of Candida.
Although the research is promising, it’s always best to speak to your OB-GYN or healthcare provider before trying boric acid. We’ll be keeping an eye on the FDA and CDC guidelines to see how they evolve based on this emerging research!
At-home treatments for yeast infections
You may have read online that at-home remedies like yogurt, garlic, and tea tree oil can clear up a yeast infection, but there’s no evidence of that. In fact, they may even do more harm than good. As frustrating as it is to deal with a stubborn yeast infection, it’s safest to stick to the recommended treatment plans. Save the yogurt for your morning granola!
Prescription treatment for yeast infections
Butoconazole
Brand name: Gynazole-1, Mycelex-3
Type of medication: Antifungal agent
Administration route: intravaginal (cream applied vaginally)
Butoconazole is an antifungal used to treat vaginal yeast infections, but sometimes it’s prescribed to treat other infections too. It comes in the form of a cream that is applied vaginally (with an applicator). It usually comes in a single dose, and the CDC recommends using 5g of the 2% cream intravaginally for 1 day.
Terconazole
Brand name: Terazol 3, Terazol 7, Zazole
Type of medication: Antifungal agent
Administration route: intravaginal (cream applied vaginally)
Terconazole is an antifungal cream that is applied in the vagina. The CDC recommends using any of the following formulations:
- 5g of the 0.4% cream intravaginally for 7 days
- 5g of the 0.8% cream for 3 days
- 80mg of the vaginal suppository daily for 3 days
Fluconazole
Brand name: Diflucan
Type of medication: Antifungal agent
Administration route: oral (pills taken by mouth)
Fluconazole is a commonly used prescription antifungal used to treat a wide range of fungal infections in the body, including some really serious ones. It’s also used to prevent fungal infections in people who are undergoing bone marrow transplants and other cancer treatments.
Unlike the other yeast infection treatments on this list, fluconazole is taken orally, so it will have a systemic effect (meaning it can kill fungi throughout the body). The CDC recommends taking a single 150mg oral dose, and it’s not recommended if you’re pregnant.
Not every itch is a yeast infection
Although most people with a vagina will experience a yeast infection at one point or another, that doesn’t mean we’re good at telling the difference between a yeast infection and other vaginal conditions — which often have similar symptoms.
In one study, only around one third of folks self-diagnosed their yeast infection correctly. Another analysis found that 74% were incorrect in self-diagnosing a yeast infection.
You get the idea — it’s hard to know what’s going on in your vaginal microbiome from symptoms alone! Taking treatment for the wrong type of fungus strain might also explain why your yeast infection keeps coming back.
Evvy’s at-home vaginal microbiome test gives you the most reliable, comprehensive results, as well as a custom plan of clear next steps. For eligible tests, we also offer integrative, prescription treatment programs.
