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Vulvovaginal Disorders

Horizontales
applied by inserting applicator into vagina and pressing plunger until it stops
Vaginal antifungal that can be administered as an ointment or cream using a pre-filled applicator and is available as a 1-day course of treatment
Causes malodourous, yellow-green, frothy discharge
Vaginal antifungal that can be administered as a suppository or cream using a vaginal insert
Causes thick, clumpy discharge that has a “cottage cheese” appearance
Vaginal antifungal that can be administered as a tablet or cream using a reusable applicator
Symptoms are not caused by C. albicans, are more likely to present in women who are immunosuppressed and should be evaluated by a healthcare provider
may provide relief of itching but does not treat underlying cause and is/are generally not recommended
vaginal suppository used for non-C. albicans infections
Used on a chronic basis, inserted into the upper vagina to relieve symptoms of GSM
alters fungi membrane permeability through decreased synthesis of ergosterol
Used with sexual activity and is applied directly to the genitals of both sexual partners to relieve symptoms of GSM
Verticales
used for resistant Candida infections
Causes thin, sometimes foamy discharge that has a “fishy” odor
May re-establish normal vaginal flora and inhibit growth of Candida organisms but data is limited and inconsistent
Bathe for 15 min PRN for relief of vulva irritation caused by VVC
Eating one cup per day may be a non-drug measure for recurrent VVC infections
Can be applied by inserting the applicator into vagina then pushing in the inside piece of the applicator as far back as possible
Proposed to contain antibacterial and antifungal properties, but effectiveness is not established; may cause allergic dermatitis
Metabolized by CYP2C9 and may cause rare drug interaction with miconazole suppositories