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Candida - female genital - Management
Which factors influence the decision to use an oral or intravaginal imidazole?
- Oral and intravaginal antifungals are equally effective for treating vulvovaginal candidiasis, and choice of therapy may be influenced by a number of factors. See Table 1 for more information.
Table 1. Factors that may influence the decision to use an oral or intravaginal imidazole for vulvovaginal candidiasis.
Factor | Topical imidazoles | Oral triazoles |
|---|
Preference and compliance issues | Some women prefer not to use pessaries or products delivered with an intravaginal applicator, which can be painful if there is particularly bad inflammation. Some women find topical cream soothing, however. | Simple and painless to use. Available as one or two doses, so few compliance issues. |
Time until effect | Antifungal cream (applied externally) may relieve symptoms sooner than an intravaginal or oral preparation alone. | Oral treatment alone may take slightly longer to take effect. |
Adverse effects | Vulval inflammation and discharge most commonly reported. | More systemic effects such as nausea, headache, and abdominal pain. |
Pregnancy | Suitable during pregnancy and breastfeeding. | Contraindicated during pregnancy and breastfeeding. |
Contraception | Products containing topical imidazoles may damage latex condoms and diaphragms. | — |
Age | Intravaginal imidazoles should generally be avoided in young girls (12–16 years) unless there is no alternative. | Oral antifungals are generally preferred for younger girls (12–16 years). |
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