Yeast infections are caused by Candida albicans, a type of fungus that is naturally found in the vaginal flora of most women. However, too much of a good thing can be bad, and overgrowth of Candida leads to a common condition for women called a yeast infection. Telltale signs include itching, soreness, and a white, thick discharge with little odor.
Given how unpleasant these symptoms can be, it’s no surprise that women are eager to skip the doctor’s visit and reach for over-the-counter (OTC) products for quick relief. Below, we’ll compare popular prescription and OTC antifungals.
Monistat and other over-the-counter antifungal creams
Most OTC antifungals contain one of the following medicines: miconazole, clotrimazole, or tioconazole. They come in cream form, are deposited via suppository or applicator (for convenience), and are available in one-, three- and seven-day regimens. The dose of a single day treatment (e.g. 1200 mg of miconazole) is stronger than a dose of a multi-day treatment (e.g. 200 mg of miconazole for three-day dose and 100 mg of miconazole nitrate per seven-day dose).
Monistat (miconazole) is the most popular brand of OTC antifungals; it claimed a 53% share of the yeast treatment market in 2014. Monistat currently has 11 separate products, each containing the medication (various application methods) and sometimes with additional personal hygiene items, like itch relief cream and cooling wipes. Prices range between $11-30.
Diflucan and other prescription antifungal medications
The most commonly prescribed treatment for yeast infection is Diflucan (fluconazole), which is an affordable generic medication. It’s also used to treat other fungal infections like Cryptococcal meningitis, athlete’s foot, and tinea versicolor (discolored patches of skin). For yeast infections, it comes as a single pill that costs as low as $4 out of pocket. When you take the pill, the medicine is dispersed through your vaginal secretions for the next 72 hours.
There are some antifungal creams you can get with a prescription, but they are more expensive ($20-$120) and not as popular. These include single-day butoconazole (Gynazole-1) and multi-day terconazole (Terazol or Zazole). They also come in just a tube (without an applicator), which may make it messier to apply.
Is Monistat or Diflucan better for me?
It really depends on how comfortable you are self-diagnosing the infection. Although yeast infections are relatively mild and uncomplicated, they can still be tricky to diagnose on your own without seeing a doctor. For example, yeast infections and bacterial vaginosis can both cause irregular vaginal discharge, while yeast infections and UTIs can both cause an itching, burning sensation — especially during urination.
Many women don’t have the time or can’t afford to see a doctor, so an OTC product makes sense as a first step, especially comparing the cost of Monistat ($11) with the cost of fluconazole ($4) plus a doctor’s visit.
If it is a yeast infection, Monistat and fluconazole both work more than 90% of the time and you should feel complete relief within seven days of your first dose. The other 10% or so of the time, you’ll eventually have to see a doctor who will do a fungal culture to determine whether it’s indeed a yeast infection, what strain of yeast it is, and what medication you need for it.
The last thing to consider is the side effects. The most common side effect with Monistat is (even more) vaginal burning, itching or irritation after insertion. Fluconazole can cause headaches, nausea, and abdominal pain, as well as interfere with some medications, such as oral contraceptives.
A note about non-antifungal medications
There are many OTC products (such as Vagisil or Summer’s Eve) targeted at vaginal issues like itchiness and irritation. It’s important to read the labels carefully because many wipes and topicals (like ointments and gels) may only help you get temporary relief, but won’t actually cure a yeast infection.
For women who don’t feel immediate symptom relief after taking their antifungal medications, Dr. Jen Gunter, fellow of the American College of Obstetricians and Gynecologists, suggests using an antihistamine like Zyrtec (cetirizine) or Claritin (loratadine) to help calm the symptoms as they wait for the antifungal kick in.
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