Support

• In the UK, the National Institute for Clinical Excellence (NICE) writes clinical guidelines for the treatment of thrush. 

• The problem with the current guidelines is that they haven't been written with the input from vulval dermatologists, largely only with BASSH input. They therefore recommend the treatment of drug-resistant thrush with back-to-back pessaries which is in contradiction to the British Association of Dermatologists and the Vulval Pain Society recommendations.

• BASSH also do not differentiate between 'uncomplicated' and 'complicated' thrush, incorporating strain and susceptibility testing for drug-resistant thrush to prevent severe infections. 

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Summary of thrush treatments from ChronicYeast.com​​

Based on USA-based CDC recommendations: 

(N.B. If pregnant - do not use oral antifungals, only pessaries). ​

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Standard treatment protocols to be taken daily until symptoms resolve (2, 5 ,6, 7, 19):

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For infections caused by candida albicans (this represents 90-95% of cases)

• Fluconazole 100mg per day orally

• Itraconazole 100mg per day orally

 

For infections caused by candida glabrata (this is the second most common vaginal candida species)

• 600mg boric acid vaginal suppositories nightly (preferred option)

• Other oral antifungals that work against candida glabrata such as voriconazole or ibrexafungerp

• Other vaginal antifungal creams that work against candida glabrata such as a combination of amphotericin B and flucytosine

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For infections caused by candida krusei, candida tropicalis, or candida parapsilosis (much less common strains)

• 600mg boric acid vaginal suppositories nightly

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For candida parapsilosis:

• itraconazole 100mg per day orally
   

For candida krusei:

• oral voriconazole or an echinocandin drug such as micafungin or caspofungin

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For candida tropicalis:

• an echinocandin drug or amphotericin B

 

If you don’t know which candida strain it is (due to absence of a positive swab), start with:

• fluconazole or itraconazole 

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Sexual partners that are asymptomatic do not need to be treated (2)

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Maintenance protocol

Once full symptom resolution is achieved (typically this can take 3 months), then the dose is gradually reduced to the lowest level that will suppress symptoms (6, 19). This varies from woman to woman — and some will not be able to reduce their dosage at all. Most women with CVVC who reach the maintenance phase are able to suppress symptoms with 50mg fluconazole twice a week (19). 

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If a course of antibiotics is necessary at any point (e.g., for a UTI, ear infection), then antifungals need to be taken daily during the antibiotic course, to prevent a relapse candida infection (2).

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Sources:

2. Day T, Sobel JD. Genital cutaneous candidiasis versus chronic recurrent vulvovaginal candidiasis: distinct diseases, different populations. Clin Microbiol Rev. 2025 Jun 12;38(2):e0002025. doi: 10.1128/cmr.00020-25. Epub 2025 May 28. PMID: 40434101; PMCID: PMC12160500.

​5. Fischer, G. Coping with Chronic Vulvovaginal Candidiasis. Medicine Today. 2014. 15:33-40.

6. Crandall, M. Overcoming Yeast Infections: A Ten-Step Program of Medical Care and Self-Help for Candidiasis. Yeast Consulting Services : YCS Press, 2023. 
7. Hong E, Dixit S, Fidel PL, Bradford J, Fischer G. Vulvovaginal candidiasis as a chronic disease: diagnostic criteria and definition. J Low Genit Tract Dis. 2014. 18:31–38.

19. Fischer, Gayle, and Jennifer Bradford. The Vulva: A Practical Handbook for Clinicians. 3rd ed., Cambridge University Press, 2023.