Guideline: Vulvovaginal candidosis (AWMF 015/072, level S2k)

Abstract

Approximately 70‐75% of women will have vulvovaginal candidosis (VVC) at least once in their lifetime. In premenopausal, pregnant, asymptomatic and healthy women and women with acute VVC, Candida albicans is the predominant species. The diagnosis of VVC should be based on clinical symptoms and microscopic detection of pseudohyphae. Symptoms alone do not allow reliable differentiation of the causes of vaginitis. In recurrent or complicated cases, diagnostics should involve fungal culture with species identification. Serological determination of antibody titres has no role in VVC. Before the induction of therapy, VVC should always be medically confirmed. Acute VVC can be treated with local imidazoles, polyenes or ciclopirox olamine, using vaginal tablets, ovules or creams. Triazoles can also be prescribed orally, together with antifungal creams, for the treatment of the vulva. Commonly available antimycotics are generally well tolerated, and the different regimens show similarly good results. Antiseptics are potentially effective but act against the physiological vaginal flora. Neither a woman with asymptomatic colonisation nor an asymptomatic sexual partner should be treated. Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose‐reducing maintenance therapy with oral triazoles. Unnecessary antimycotic therapies should always be avoided, and non‐albicans vaginitis should be treated with alternative antifungal agents. In the last 6 weeks of pregnancy, women should receive antifungal treatment to reduce the risk of vertical transmission, oral thrush and diaper dermatitis of the newborn. Local treatment is preferred during pregnancy.

Validation of the SavvyCheck™ Vaginal Yeast Test for Screening Pregnant Women for Vulvovaginal Candidosis: A Prospective, Cross-Sectional Study

“…Women are at increased risk of acquiring VVC during pregnancy [9,23]. An easyto-use point-of-care test could screen for VVC in the absence of cost-intensive medical facilities [16].…”

“…We chose this procedure for the sake of cost reduction, and as we know, Gram stain is reliable for diagnosing candidosis under the microscope. Moreover, Candida albicans is a commensal fungus that is able to colonize the female genital tract without transiting into a pathogen that causes VVC [9]; therefore, screening asymptomatic women might also be controversial. However, we considered this procedure reasonable, as this test requires a certain fungal load for a positive test result.…”

“…The prevalence of Candida during pregnancy has been reported to be at least 20% if colonization is examined by culture. The predominant species is Candida albicans, followed by non-albicans species that are often accompanied by milder symptoms and more likely to develop during pregnancy [9]. Of note, pregnancy itself increases the risk of acquiring VVC due to immunologic alterations, increased vaginal glycogen accumulation promoted by rising levels of estrogen, and reduced vaginal pH [9,10].…”

Effects of oestrogen on vulvovaginal candidosis

“…25 It can stimulate NLRP3 inflammasome, induce macrophages to secrete mature IL-1β and activate the MAPK signalling pathway of endothelial cells to secrete chemokines to recruit neutrophils to the infected site. 69,70 However, as C. albicans originally colonises vaginal mucosa in women, it still remains unknown which factor induces the morphological transition and a series of subsequent reactions.…”

Vaginales Mikrobiom und Darmmikrobiom – ein Crosstalk

“…Deshalb bekommen Kinder und Frauen ohne Hormonsubstitution nach den Wechseljahren keine Vaginalmykosen, selbst wenn sie (seltener und in geringerem Ausmaß als prämenopausal) vaginal kolonisiert sein sollten. Hautmykosen im Vulva-oder Leistenbereich sind bei entsprechender Disposition aber in jedem Alter möglich [14].…”