What are the recommended first-line treatments for vulvovaginal candidiasis in non-pregnant women?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Recommended first-line treatments for vulvovaginal candidiasis in non-pregnant women:

  • Oral fluconazole 150 mg as a single dose is advised first-line for acute vulvovaginal candidiasis.
  • If oral therapy is contraindicated or not tolerated, clotrimazole 500 mg intravaginal pessary as a single dose is recommended as an alternative first-line treatment.
  • 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 cases of severe infection, a repeat dose of oral fluconazole 150 mg on day 4 is advised.

These treatments are suitable for women aged 16 years and older and should be selected based on individual factors such as co-morbidities, personal preference, and drug contraindications.

Educational content only. Always verify information and use clinical judgement.

What are the recommended first-line treatments for vulvovaginal candid