Management of Recurrent Vulvo-Vaginal Candidosis as a Chronic Illness

Abstract

For sporadic acute Candida vaginitis, any oral or local antifungal therapy can be used. For women with recurrent vulvo-vaginal candidosis (RVC), on the other hand, such simple approaches are insufficient, regardless of the product chosen. Instead, RVC should be managed as any other chronic disease and requires long-term, prophylactic, suppressive antifungal treatment. A regimen using individualized, decreasing doses of oral fluconazole (the ReCiDiF regimen) was proven to be highly efficient and offered great comfort to the patients. During this regimen, it is crucial that patients are carefully examined by anamnestic, clinical, microscopic and culture-proven absence of Candida. If a relapse occurs, the medication is adjusted and efforts are taken to find a possible triggering factor for the reactivation of the infection. Care has to be taken not to accumulate ‘don’t do’s’, unless the efficiency of a measure has been proven, by trying to eliminate one risk factor at a time for 2 months. Known possible triggers to be kept in mind are (1) antibiotic use, (2) use of specific contraceptives, especially combined contraceptive pills, (3) disturbed glucose metabolism, (4) the use of personal hygienic products, and (5) tight clothing or plastic panty liners. In therapy-resistant cases, non-albicans infection must be ruled out, and alternative therapies should be tried. Boric acid is proven to be efficient in most of these resistant cases, but other non-azoles like amphotericin B, flucytosine, gentian violet, and even caspofungin may have to be tried. As a final remark it has to be said that many patients feel poorly understood and inefficiently managed by many care-givers, increasing their feelings of guilt and sexual inferiority. Therefore, attention has to be given to take the disease seriously, follow strict treatment regimens, and advise precisely and based on individual evidence concerning any possible risk factors for recurrence. In case of therapy-resistant vulvo-vaginitis, reconsider your diagnosis and/or consider referral to specialized therapists.

Efficacy of Itraconazole Versus Fluconazole in Vulvovaginal Candidiasis: An in Vivo Study

“…However, more local studies are required to be done for the evaluation of therapeutic efficacy of these antifungal drugs. 14,15 Our results regarding high relapse rate with fluconazole compared to itraconazole were also consistent with international data reported earlier. 12 This is probably, because that itraconazole is highly active against most common fungi.…”

Miconazole Nitrate Vaginal Suppository 1,200 mg versus Oral Fluconazole 150 mg in Treating Severe Vulvovaginal Candidiasis

“…The 2-dose oral fluconazole regimen currently becomes a standard regimen for the treatment of complicated VVC [3]. Miconazole can be used to treat VVC and recurrent VVC [1,3,15]. The miconazole nitrate suppository 1,200 mg consists of 1,200 mg of miconazole nitrate and inactive ingredients.…”

<b><i>Candida glabrata</i></b> Chorioamnionitis following in vitro Fertilization: Review of the Literature

“…It is probable that these cases are underdiagnosed and therefore underreported, and screening would possibly enable treatment of such women in further IVF-assisted pregnancies. Several cases of successful treatment have been described [6,7], noting the difference in approach between local vaginal and systemic treatment in view of potential preexisting seeding in the uterus [27]. …”