Recurrent genital candidosis in women and the effect of intermittent prophylactic treatment

Davidson, Fiona; Mould, Richard F.

doi:10.1136/sti.54.3.176

Cited by 33 publications

(14 citation statements)

References 16 publications

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“…Similar results can be achieved using daily ketoconazole or daily or alternate day itraconazole [6]. Likewise, intravaginal or topical azoles have the same suppressive effect when used long term [8]. Notably, women prefer the convenience of oral therapy for long-term use, and the convenience and tolerance of a once-weekly regimen clearly explain the popularity of this regimen.…”

Section: Principles Of Therapymentioning

confidence: 56%

Management of recurrent vulvovaginal candidiasis: Unresolved issues

Sobel

2006

Curr Infect Dis Rep

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The introduction and widespread use of long-term maintenance suppressive fluconazole prophylaxis for recurrent vulvovaginal candidiasis (RVVC) has improved the quality of life for thousands of women worldwide. Moreover, the regimen is no longer expensive, and it is safe and well tolerated. However, the regimen frequently fails to cure the condition and serves only as an effective control measure in many cases. Moreover, some women are unable to tolerate the regimen, and new curative approaches are needed. This review presents the limitations of this suppressive regimen and a discussion of the possible reasons for these limitations and failure to cure. Also, the rationale for new drug development is reviewed here.

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Section: Principles Of Therapymentioning

confidence: 56%

Management of recurrent vulvovaginal candidiasis: Unresolved issues

Sobel

2006

Curr Infect Dis Rep

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“…Because infection requires colonisation and disposition and treatment of the underlying disposition (local weakness of the immune system) has not yet been attempted, local and oral maintenance treatments are recommended for the prevention of recurrences . The results are comparable regardless of whether local clotrimazole 500 mg, oral ketoconazole 100 mg or oral fluconazole 150 mg is administered.…”

Section: Treatmentmentioning

confidence: 99%

Guideline: Vulvovaginal Candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis)

Mendling

2015

Mycoses

103

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The oestrogenised vagina is colonised by Candida species in at least 20% of women; in late pregnancy and in immunosuppressed patients, this increases to at least 30%. In most cases, Candida albicans is involved. Host factors, particularly local defence mechanisms, gene polymorphisms, allergies, serum glucose levels, antibiotics, psycho-social stress and oestrogens influence the risk of candidal vulvovaginitis. Non-albicans species, particularly Candida glabrata, and in rare cases also Saccharomyces cerevisiae, cause less than 10% of all cases of vulvovaginitis with some regional variation; these are generally associated with milder signs and symptoms than normally seen with a C. albicans-associated vaginitis. Typical symptoms include premenstrual itching, burning, redness and odourless discharge. Although itching and redness of the introitus and vagina are typical symptoms, only 35-40% of women reporting genital itching in fact suffer from vulvovaginal candidosis. Medical history, clinical examination and microscopic examination of vaginal content using 400× optical magnification, or preferably phase contrast microscopy, are essential for diagnosis. In clinically and microscopically unclear cases and in chronically recurring cases, a fungal culture for pathogen determination should be performed. In the event of non-C. albicans species, the minimum inhibitory concentration (MIC) should also be determined. Chronic mucocutaneous candidosis, a rarer disorder which can occur in both sexes, has other causes and requires different diagnostic and treatment measures. Treatment with all antimycotic agents on the market (polyenes such as nystatin; imidazoles such as clotrimazole; and many others including ciclopirox olamine) is easy to administer in acute cases and is successful in more than 80% of cases. All vaginal preparations of polyenes, imidazoles and ciclopirox olamine and oral triazoles (fluconazole, itraconazole) are equally effective (Table ); however, oral triazoles should not be administered during pregnancy according to the manufacturers. C. glabrata is not sufficiently sensitive to the usual dosages of antimycotic agents approved for gynaecological use. In other countries, vaginal suppositories of boric acid (600 mg, 1-2 times daily for 14 days) or flucytosine are recommended. Boric acid treatment is not allowed in Germany and flucytosine is not available. Eight hundred-milligram oral fluconazole per day for 2-3 weeks is therefore recommended in Germany. Due to the clinical persistence of C. glabrata despite treatment with high-dose fluconazole, oral posaconazole and, more recently, echinocandins such as micafungin are under discussion; echinocandins are very expensive, are not approved for this indication and are not supported by clinical evidence of their efficacy. In cases of vulvovaginal candidosis, resistance to C. albicans does not play a significant role in the use of polyenes or azoles. Candida krusei is resistant to the triazoles, fluconazole and itraconazole. For this reason, local imidazole, ciclopi...

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“…The evidence for maintenance regimens (none FDA approved) is strongest for topical clotrimazole (500-mg suppository once weekly), 110 oral ketoconazole (400 mg daily for 5 days followed by 100 mg daily), 109 itraconazole (200 mg twice daily for 3 days followed by 100-200 mg daily), 111 and oral fluconazole (150 mg every 3 days for 3 doses followed by 150 mg once weekly). 112,113 Because of its tolerability, convenience, and excellent activity against C albicans, fluconazole is the preferred medication.…”

Section: Recurrent Vvcmentioning

confidence: 99%

Genital Mycotic Infections in Patients With Diabetes

Nyirjesy

Sobel

2013

Postgraduate Medicine

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Patients with diabetes, especially those with poorly controlled glycemia, are prone to developing genital mycotic infections-vulvovaginal candidiasis in women and Candida balanitis in men-the latter almost exclusively in uncircumcised men. Candida albicans is the most common pathogen causing balanitis and is also the dominant cause of vulvovaginal candidiasis in women with diabetes, although Candida glabrata is a prominent pathogen in women with type 2 diabetes mellitus. Candida glabrata is less virulent but also less susceptible to conventional antifungal treatment. High blood glucose levels promote yeast attachment and growth, and also interfere with immune responses in the host. In uncircumcised men, the moist, warm space underneath the foreskin is thought to promote yeast growth, especially when hygiene is poor. Several other risk factors have been identified that predispose to genital mycotic infections, including antibiotic use, corticosteroid use, immunosuppression, atopy, and, in women only, genetics, pregnancy, estrogen/oral contraceptive use, and select sexual behaviors (eg, orogenital sex). In patients with hyperglycemia, risk is increased for not only incident infection but also for recurrence, underscoring the key role of establishing and maintaining euglycemia in the management of genital mycotic infections in patients with diabetes. In addition to blood glucose control, first-line treatment involves either an antifungal cream/ointment (or suppository for women only) that is applied intravaginally by women and directly to the affected area(s) by men, or oral treatment, which infrequently causes systemic side effects. Antifungal treatment should also be offered to sexual partners of patients with diabetes with a genital mycotic infection if the partner is similarly infected. Given high efficacy rates, follow-up test-of-cure after the completion of treatment is generally unnecessary.

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Recurrent genital candidosis in women and the effect of intermittent prophylactic treatment

Cited by 33 publications

References 16 publications

Management of recurrent vulvovaginal candidiasis: Unresolved issues

Management of recurrent vulvovaginal candidiasis: Unresolved issues

Guideline: Vulvovaginal Candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis)

Genital Mycotic Infections in Patients With Diabetes

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