Yeast infections, medically known as vulvovaginal candidiasis (VVC), are common fungal infections affecting many women. While occasional episodes are common, not worrisome, and managed with standard treatments, recurrent infections—defined as four or more episodes in a year—pose a significant challenge. Fortunately, recent advancements have introduced new medications and strategies to address both acute and chronic yeast infections effectively.
New and Noteworthy Medications
1. Brexafemme (Ibrexafungerp)
Approved by the FDA in 2021, Brexafemme represents the first new class of antifungal therapy for vaginal yeast infections in over 20 years. Unlike traditional azole antifungals, it works by inhibiting glucan synthase, an enzyme crucial for fungal cell wall integrity. It’s taken orally and is especially promising for those with resistance or intolerance to standard treatments.
2. Vivjoa (Oteseconazole)
Approved in 2022, Vivjoa is the first FDA-approved medication specifically for recurrent vulvovaginal candidiasis (RVVC). It’s indicated for postmenopausal and permanently infertile women. Vivjoa selectively inhibits a fungal enzyme (CYP51), blocking fungal cell membrane synthesis. Clinical trials showed that up to 96% of women remained yeast infection-free during a 48-week trial. However, Vivjoa is not recommended for use during pregnancy or by individuals who may become pregnant due to its teratogenic potential.
Managing Chronic or Recurrent Infections
For women with frequent infections, maintenance therapy is a key strategy. According to CDC guidelines, the following options are effective:
- Oral Fluconazole: 150 mg once weekly for 6 months significantly reduces recurrence.
- Topical Antifungals: For those who can’t tolerate oral therapy, weekly intravaginal treatments such as clotrimazole (500 mg pessary) or terconazole may be used over a similar period.
It’s important to note that these regimens manage recurrence but may not provide a permanent cure. Continued evaluation and individualized care are essential, especially for those with underlying risk factors like diabetes, high estrogen states, or antibiotic overuse.
Conclusion
Treatment for yeast infections has evolved significantly. It is important not to self treat if you have resistant or recurrent infections. New medications like Brexafemme and Vivjoa provide alternatives for those who struggle with recurrent or resistant infections. For individuals with chronic VVC, weekly antifungal therapy remains a cornerstone of long-term management. Anyone dealing with frequent episodes should consult their healthcare provider to explore these newer therapies and develop a personalized treatment plan.
