What are the recommended first-line treatments for uncomplicated vulvovaginal candidiasis in adult women?

Recommended first-line treatments for uncomplicated vulvovaginal candidiasis in adult women include:

• Oral fluconazole 150 mg as a single dose, unless contraindicated.
• If oral therapy is contraindicated or not tolerated, clotrimazole 500 mg intravaginal pessary as a single dose is recommended.
• For women with vulval symptoms, consider adding topical clotrimazole cream (1% or 2%) applied 2–3 times daily alongside oral or intravaginal antifungal treatment.
• In pregnancy or women at risk of pregnancy, topical imidazole treatments such as clotrimazole pessary 500 mg intravaginally at night for up to 7 consecutive nights are preferred over oral azoles due to safety concerns.

Follow-up is advised if symptoms persist beyond 7–14 days or if infection is recurrent. Routine treatment of asymptomatic male partners is not recommended.

Topical imidazole preparations may damage latex condoms and diaphragms, so advise accordingly.

Self-management advice includes avoiding irritants, using simple emollients, and avoiding douching or tight/non-absorbent clothing.

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