Treatment of Vulvovaginal Candidiasis—An Overview of Guidelines and the Latest Treatment Methods

Abstract

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations regarding VVC treatment, as well as novel treatment options. Topical and oral azoles are the drugs of choice in uncomplicated mycosis. The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines. Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent. Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole. The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described. We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines. Thus far, few precise recommendations are available in the literature. Future studies should focus on atypical VVC forms to elucidate the inconsistent findings.

Patients with recurrent vulvovaginal candidiasis exhibit a decrease in both the fungicidal activity of neutrophils and the proliferation of peripheral blood mononuclear cells

“…Azoles, mainly FLC, are the first line of treatment against VVC 30 . However, the inappropriate use of this type of antifungal has contributed to the development of resistance by Candida spp.…”

Vaginal candidiasis, predisposing factors, symptoms and treatment

“…Los criterios que definen la infección no complicada son: episodios esporádicos e infrecuentes (≤3 episodios por año), signos y síntomas leves a moderados, posible infección por C. albicans y mujeres sanas, no embarazadas e inmunocompetentes. Las infecciones complicadas se caracterizan por signos y síntomas graves, especies de Candida no albicans (principalmente C. glabrata), embarazo, diabetes mal controlada, inmunosupresión y antecedentes de CVVR confirmado mediante cultivos repetidos (21). La mera presencia de la levadura Candida no es un signo de enfermedad, ya que puede formar parte de la microflora normal de las mujeres.…”

“…Los tratamientos más utilizados se basan en azoles, especialmente fluconazol, que son bacteriostáticos contra Candida y actúan uniéndose e inhibiendo las enzimas intracelulares implicadas en la biosíntesis y conversión de ergosterol en lanosterol (3,15). Los agentes antimicóticos orales y tópicos han logrado tasas de curación clínica comparables en ensayos aleatorios (20,21), por lo que la elección del tratamiento debe basarse en la preferencia del paciente (20). El azol generalmente se tolera bien, pero algunos efectos secundarios incluyen dolor de cabeza, malestar estomacal y náuseas después de la administración oral y relaciones sexuales dolorosas o irritación después de la administración vaginal (22).…”

Uso de vacina imunoestimulante para candidíase vulvovaginal: uma revisão integrativa de literatura

“…Os não complicados, responsáveis por até 90% de todos os casos de candidíase, são episódios esporádicos de infecções leves causadas por C. albicans. Já os casos complicados incluem infecções severas provocadas por espécies de Candida não albicans, CVV recorrente (RVVC), CVV durante a gravidez ou em associação a outras condições médicas, como imunossupressão ou diabetes (SATORA et al 2023).…”

“…As pacientes costumam descrever o corrimento como espesso, de cor branca e semelhante à coalhada. No exame físico, são observados fluxo vaginal visível, eritema na região vulvar e vaginal e, menos comumente, abrasões ou fissuras (SATORA et al 2023). Além das manifestações clínicas, e mesmo não estando associada à mortalidade, os efeitos da RVVC nas relações íntimas e na vida diária das mulheres podem ser significativos, devido a sua frequência e imprevisibilidade (EDWARDS Jr et al 2018).…”