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Critical Reviews in Microbiology Nov 2016Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC,... (Review)
Review
Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC, the identification of non-Candida albicans Candida (NCAC) species, especially Candida glabrata, as the cause of this infection, appears to be increasing. The development of VVC is usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or nonphysiological changes. Several host-related and behavioral risk factors have been proposed as predisposing factors for VVC. Host-related factors include pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotics, glucocorticoids use and genetic predispositions. Behavioral risk factors include use of oral contraceptives, intrauterine device, spermicides and condoms and some habits of hygiene, clothing and sexual practices. Despite a growing list of recognized risk factors, much remains to be elucidated as the role of host versus microorganisms, in inducing VVC and its recurrence. Thus, this review provides information about the current state of knowledge on the risk factors that predispose to VVC, also including a revision of the epidemiology and microbiology of VVC, as well as of Candida virulence factors associated with vaginal pathogenicity.
Topics: Candida; Candidiasis, Vulvovaginal; Female; Humans; Pregnancy; Risk Factors
PubMed: 26690853
DOI: 10.3109/1040841X.2015.1091805 -
Mycoses Jun 2021Approximately 70-75% of women will have vulvovaginal candidosis (VVC) at least once in their lifetime. In premenopausal, pregnant, asymptomatic and healthy women and... (Review)
Review
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.
Topics: Anti-Bacterial Agents; Antifungal Agents; Candida albicans; Candida glabrata; Candidiasis, Vulvovaginal; Causality; Ciclopirox; Contraceptive Agents; Diabetes Mellitus; Female; Hormones; Humans; Hyphae; Imidazoles; Infant, Newborn; Polyenes; Pregnancy; Vaginitis
PubMed: 33529414
DOI: 10.1111/myc.13248 -
BMJ Clinical Evidence Mar 2015Vulvovaginal candidiasis is estimated to be the second most common cause of vaginitis after bacterial vaginosis. Candida albicans accounts for 85% to 90% of cases. (Review)
Review
INTRODUCTION
Vulvovaginal candidiasis is estimated to be the second most common cause of vaginitis after bacterial vaginosis. Candida albicans accounts for 85% to 90% of cases.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of drug treatments for acute vulvovaginal candidiasis in non-pregnant symptomatic women? What are the effects of alternative or complementary treatments for acute vulvovaginal candidiasis in non-pregnant symptomatic women? What are the effects of treating asymptomatic non-pregnant women with a positive swab for candidiasis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 23 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review, we present information relating to the effectiveness and safety of the following interventions: alternative or complementary treatments; douching; drug treatments; garlic; intravaginal preparations (nystatin, imidazoles, tea tree oil); oral fluconazole; oral itraconazole; and yoghurt containing Lactobacillus acidophilus (oral or intravaginal).
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Complementary Therapies; Female; Fluconazole; Humans; Itraconazole; Yogurt
PubMed: 25775428
DOI: No ID Found -
Mayo Clinic Proceedings Feb 2022Vaginitis is a common concern for women across the lifespan. Vaginal symptoms may impact quality of life, and clinicians are challenged in the evaluation and management... (Review)
Review
Vaginitis is a common concern for women across the lifespan. Vaginal symptoms may impact quality of life, and clinicians are challenged in the evaluation and management of bacterial vaginosis, Candida vaginitis, trichomoniasis, desquamative inflammatory vaginitis, and genitourinary syndrome of menopause.
Topics: Anti-Bacterial Agents; Candidiasis, Vulvovaginal; Female; Humans; Quality of Life; Vagina; Vaginosis, Bacterial
PubMed: 35120697
DOI: 10.1016/j.mayocp.2021.09.022 -
Frontiers in Cellular and Infection... 2023Vaginal microbiome is mutually beneficial to the host and has a significant impact on health and disease. species, including , are part of the mucosal flora of most... (Review)
Review
Vaginal microbiome is mutually beneficial to the host and has a significant impact on health and disease. species, including , are part of the mucosal flora of most healthy women. Under suitable conditions, they can live in the vulvovaginal mucosa, resulting in symptomatic vulvovaginal candidiasis (VVC). Based on the analysis of 16S ribosomal RNA gene sequences, great progress has been made in exploring the composition and structure of vaginal bacterial community. Moreover, researchers have conducted several studies on whether vaginal microbiome will change during VVC infection. In addition, it has been reported that vaginal colonization of probiotics in vaginal microorganisms, especially , can effectively reduce the risk of VVC and treat VVC. This review aims to summarize the changes of vaginal microflora during VVC infection, and further point out the possibility of using lactic acid bacteria as probiotics to treat VVC, so as to reduce the adverse consequences of VVC infection and reduce the expensive treatment cost.
Topics: Female; Humans; Candidiasis, Vulvovaginal; Vagina; Candida albicans; Candida; Probiotics; Antifungal Agents
PubMed: 36816582
DOI: 10.3389/fcimb.2023.1123026 -
American Journal of Obstetrics and... Jan 2016Recurrent vulvovaginal candidiasis (RVVC) is a common cause of significant morbidity in women in all strata of society affecting millions of women worldwide. Previously,... (Review)
Review
Recurrent vulvovaginal candidiasis (RVVC) is a common cause of significant morbidity in women in all strata of society affecting millions of women worldwide. Previously, RVVC occurrence was limited by onset of menopause but the widespread use of hormone replacement therapy has extended the at-risk period. Candida albicans remains the dominant species responsible for RVVC, however optimal management of RVVC requires species determination and effective treatment measures are best if species-specific. Considerable progress has been made in understanding risk factors that determine susceptibility to RVVC, particularly genetic factors, as well as new insights into normal vaginal defense immune mechanisms and their aberrations in RVVC. While effective control of RVVC is achievable with the use of fluconazole maintenance suppressive therapy, cure of RVVC remains elusive especially in this era of fluconazole drug resistance. Vaccine development remains a critical challenge and need.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Genetic Predisposition to Disease; Humans; Probiotics; Recurrence
PubMed: 26164695
DOI: 10.1016/j.ajog.2015.06.067 -
Dermatologic Therapy Jul 2019Dermatologists commonly prescribe medications such as antibiotics and corticosteroids that can increase the risk for candidiasis. Though conventional antifungals are... (Review)
Review
Dermatologists commonly prescribe medications such as antibiotics and corticosteroids that can increase the risk for candidiasis. Though conventional antifungals are often effective against candidiasis, they are not without side effects and species of Candida are gaining resistance. Probiotics help treat conditions such as post-antibiotic diarrhea and infectious diarrhea, and thus have the potential to help with Candida infections, as well. For this reason, we provide an overview of therapies prescribed in dermatology that may increase the risk for candidiasis, and we review the literature on whether probiotics are useful in the treatment and prevention of oral and vulvovaginal candidiasis to help dermatologists treating the condition be better informed about their supplemental use with conventional antifungals.
Topics: Antifungal Agents; Candida albicans; Candidiasis, Oral; Candidiasis, Vulvovaginal; Female; Humans; Probiotics
PubMed: 31112355
DOI: 10.1111/dth.12970 -
Frontiers in Cellular and Infection... 2021Mixed vaginitis is the simultaneous presence of at least two types of vaginitis, contributing to an abnormal vaginal milieu and leading to vaginal symptoms and signs.... (Review)
Review
Mixed vaginitis is the simultaneous presence of at least two types of vaginitis, contributing to an abnormal vaginal milieu and leading to vaginal symptoms and signs. However, associations between symptoms and the type of mixed vaginitis have not been clearly elucidated, and research on mixed vaginitis is still in the preliminary stage. Therefore, the pathogenic mechanism of mixed vaginitis remains understudied. Mixed vaginitis generally involves the formation of mixed biofilms. The study of polymicrobial interactions and mixed biofilms will provide a new idea for the understanding of mixed vaginitis. Moreover, this review summarizes some effective management and laboratory diagnosis of mixed vaginitis to avoid inappropriate therapy, recurrence, and reinfection. It is of high clinical importance to obtain relevant clinical data to improve clinical knowledge about mixed vaginitis.
Topics: Candidiasis, Vulvovaginal; Female; Humans; Vulvovaginitis
PubMed: 34796129
DOI: 10.3389/fcimb.2021.759795 -
Clinical Infectious Diseases : An... Apr 2022Vulvovaginal candidiasis (VVC) is a common cause of vulvovaginal itching and discharge. This article discusses the latest CDC STI Treatment Guidelines for VVC. (Review)
Review
BACKGROUND
Vulvovaginal candidiasis (VVC) is a common cause of vulvovaginal itching and discharge. This article discusses the latest CDC STI Treatment Guidelines for VVC.
METHODS
A literature search of relevant topics was performed, and a team of experts was convened to discuss (1) diagnosis/testing modalities; treatment of (2) uncomplicated VVC , (3) complicated VVC, and (4) VVC caused by non-albicans yeast; (5) alternative treatment regimens; (6) susceptibility testing of yeast; Special Populations: (7) pregnancy and (8) HIV and VVC.
RESULTS
Yeast culture remains the gold standard for diagnoses. Newer molecular assays have been developed for the diagnosis of VVC and perform well. Azole antifungals remain the treatment of choice for uncomplicated VVC. Two new drugs, TOL-463 and recently FDA-approved ibrexafungerp, appeared promising in clinical trials. For recurrent VVC, oteseconazole, not yet commercially available, may represent a new option. For non-albicans yeast infections in symptomatic patients, boric acid appears useful. No evidence supports the use of alternative treatments, including probiotics. Fluconazole during pregnancy may be associated with spontaneous abortion and craniofacial and heart defects. In women with HIV infection, lower CD4+ T-cell counts are associated with increased rates of VVC, and VVC is associated with increased viral shedding. Treatment measures in women with HIV infection are identical to those women without HIV infection.
CONCLUSIONS
There has been significant new knowledge generated about VVC since the 2015 CDC Guidelines which have led to changing recommendations.
Topics: Antifungal Agents; Candida albicans; Candidiasis, Vulvovaginal; Centers for Disease Control and Prevention, U.S.; Female; Fluconazole; HIV Infections; Humans; Pregnancy; Saccharomyces cerevisiae; United States
PubMed: 35416967
DOI: 10.1093/cid/ciab1057 -
Obstetrics and Gynecology Clinics of... Jun 2023Vulvovaginitis occurs in mostly reproductive aged women. Recurrent vaginitis affects overall quality of life, with a large financial burden on the patient, family, and... (Review)
Review
Vulvovaginitis occurs in mostly reproductive aged women. Recurrent vaginitis affects overall quality of life, with a large financial burden on the patient, family, and health system. This review discusses a clinician's approach to vulvovaginitis with specific attention to the 2021 updated Center for Disease Control and Prevention guidelines. The authors discuss the role of the microbiome in vaginitis and evidence-based approaches for diagnosis and treatment of vaginitis. This review also provides updates on new considerations, diagnosis, management, and treatment of vaginitis. Desquamative inflammatory vaginitis and genitourinary syndrome of menopause are discussed as differential diagnosis of vaginitis symptoms.
Topics: Female; Humans; Adult; Vaginosis, Bacterial; Quality of Life; Vulvovaginitis; Vaginitis; Microbiota
PubMed: 37149312
DOI: 10.1016/j.ogc.2023.02.005