Acne Antibiotics and Vaginal Yeast Infections — If They Keep Coming Back on Acne Medication

Three-Line Summary

• Some women who take antibiotics by mouth for acne can develop a vaginal yeast infection. In a presentation at the 2025 annual meeting of the American College of Obstetricians and Gynecologists (ACOG), the risk of developing a yeast infection within 6 months of taking the drug was reported to be about 2.3 times as high with azithromycin and about 1.2 times as high with doxycycline, and no significant increase was found with minocycline and erythromycin.
• The explanation given is that antibiotics reduce the normal bacterial flora inside the vagina (Lactobacillus and others), which creates an environment in which Candida can easily overgrow.
• If symptoms of vaginitis develop, we recommend that you see a gynecologist, and that you discuss the type of antibiotic with your doctor if vaginitis keeps recurring or you have a history of recurrent vaginitis. Whether to continue the medication or change it is decided in consultation rather than on your own.

Oral Antibiotics Used in Acne Treatment

There are many ways to treat acne, and among the medications taken by mouth the main ones are antibiotics and isotretinoin, a sebum-suppressing drug. A medication that has an effect is bound to have side effects as well, and this article deals with the antibiotics.

When acne is severe, antibiotics taken by mouth (oral antibiotics) are often prescribed together with topical antibiotics such as clindamycin and erythromycin. The oral antibiotics used for acne include doxycycline, minocycline, azithromycin and erythromycin.

In general, doxycycline and minocycline are the ones mainly prescribed, and occasionally roxithromycin, a macrolide like erythromycin, is used as well. On the whole, doxycycline and minocycline tend to be effective and roxithromycin is regarded as somewhat weaker than these, but how well a drug works varies from person to person, and some people respond better to roxithromycin.

How acne treatment as a whole is put together is set out in our acne treatment guide. Topical medications that can be bought at a pharmacy are covered separately in our article on pharmacy acne ointments.

The Link Between Acne Antibiotics and Vaginal Yeast Infections — A Study Presented in 2025

A large study on this link was presented at the 2025 annual meeting of the American College of Obstetricians and Gynecologists (ACOG). An analysis of data from more than 139,000 women with acne reported that, compared with acne patients who had not taken any of the four antibiotics, the risk of developing a vaginal yeast infection within 6 months of taking the drug was significantly higher: about 2.3 times as high with azithromycin (hazard ratio 2.35) and about 1.2 times as high with doxycycline (hazard ratio 1.24).

The Risk Differed by Antibiotic

Broken down by antibiotic, what was presented is as follows. You can find out which active ingredient is in the medication you are currently taking from the clinic that prescribed it or from a pharmacy.

• Azithromycin — reported to carry the highest risk of a vaginal yeast infection.
• Doxycycline — the risk was significantly higher, but the increase was smaller than with azithromycin.
• Minocycline and erythromycin — no statistically significant increase in risk was found.

The presenters concluded that azithromycin and doxycycline significantly raise the risk of a vaginal yeast infection in the 6 months after treatment, and that these findings can guide decision-making when oral antibiotics are prescribed for acne. So if you are a woman with a history of recurrent vaginitis, it is advisable to discuss the choice of antibiotic thoroughly with your doctor.

That said, this is an account, as of June 2025, of a retrospective data analysis presented as an abstract at a scientific meeting. A higher reported risk does not mean that everyone who takes the drug will develop vaginitis, and the fact that no significant increase was found does not mean that it will not occur.

Why Would Taking Antibiotics Lead to Vaginitis?

A vaginal yeast infection is vaginitis caused by a fungus (a yeast) called Candida, and it is also called Candida vaginitis or vaginal candidiasis (vulvovaginal candidiasis). Normal bacterial flora such as Lactobacillus live inside the vagina, and antibiotics reduce this flora and, as a result, create an environment in which Candida can easily overgrow.

This is because the antibacterial action of antibiotics reaches widely and reduces the bacteria that benefit the body as well. It also means that not all bacteria are harmful. This is also why using antibiotics more than necessary is cited as a typical risk factor for vaginal yeast infections.

Symptoms and Diagnosis of a Vaginal Yeast Infection

The symptoms that mainly appear with a vaginal yeast infection are as follows.

• Vaginal itching
• A burning sensation
• A white, cottage cheese-like discharge
• Erythema (redness) of the vulva

If these symptoms appear or keep recurring while you are taking acne medication, a link with the medication is worth looking at as well. In making the diagnosis, the symptoms are checked; in addition, Candida hyphae are sometimes confirmed under a microscope, and a culture is sometimes done if needed. That is why it is better to be seen by a gynecologist than to judge for yourself from symptoms alone.

Treating a Vaginal Yeast Infection — Decided by Your Gynecologist

Vaginal yeast infections are treated by a gynecologist. Here we give only the broad outline of the guidelines, so that you can refer to it at your appointment.

As of June 2025, when this article was first put together, guidelines from the US Centers for Disease Control and Prevention (CDC) and the American College of Obstetricians and Gynecologists (ACOG), as well as European guidelines, state that most vaginal yeast infections respond well to a topical antifungal in the form of a vaginal suppository or cream, or to oral fluconazole. Depending on the case, treatment is divided as follows.

• Simple (uncomplicated) yeast infection — vaginal suppositories or creams such as clotrimazole, miconazole or tioconazole are used, or oral fluconazole. Oral fluconazole is not used during pregnancy.
• Recurrent or complicated yeast infection — the options set out are a longer course of topical treatment or long-term use of fluconazole.

Which drug is used, and for how long, depends on the diagnosis. We recommend having this decided by a gynecologist rather than obtaining a medication and using it on your own.

If You Are Pregnant

During pregnancy, only topical creams (clotrimazole in particular) should be used, not oral antifungals. Your obstetrician or gynecologist can guide you on this as well.

If You Develop Vaginitis While Taking Acne Medication

It comes down to four things.

• If symptoms develop, see a gynecologist first — if symptoms of vaginitis develop while you are taking antibiotics for acne, please see a gynecologist without putting it off.
• If you have a history of recurrent vaginitis, discuss the choice of antibiotic — other drugs such as minocycline or erythromycin can be considered when the antibiotic is chosen.
• Antibiotics only when needed, and for the minimum period — it is recommended that oral antibiotics be taken only when needed and for as short a period as possible.
• Everyday care — everyday care for vaginal health, such as wearing cotton underwear and not overusing feminine washes, also matters in preventing vaginitis.

Whether to Continue or Change the Medication Is Decided in Consultation

If vaginitis keeps recurring during acne treatment, we recommend having the type of antibiotic adjusted or consulting a gynecologist. Whether to continue the medication you are taking or change it is then better decided in discussion with the doctor who prescribed it than on your own. This is because each drug differs in how well it works for acne, and there is individual variation as well, so it is hard to decide by looking at the risk of vaginitis alone.

It is hard for the doctor prescribing your acne medication to know that you have had vaginitis. If you have had symptoms of vaginitis or have a history of recurrent vaginitis, please mention it first at your appointment. It can be taken into account in choosing the antibiotic, and it helps in looking after your skin and your vaginal health together.

This article is a general explanation and does not replace an individual diagnosis. Diagnosing and treating vaginitis requires seeing a gynecologist.

References

1. Gurram A, et al. Differential Rates of Vulvovaginal Candidiasis Across Oral Antibiotic Use for Acne Treatment: A Large Database Retrospective Review Using TriNetX. Abstract presented at: 2025 American College of Obstetricians and Gynecologists (ACOG) Annual Clinical and Scientific Meeting; May 16-18, 2025; Minneapolis, MN.
2. Ebert M. Certain acne antibiotics linked to higher risk of vaginal yeast infections. Contemporary OB/GYN. May 16, 2025.