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Colloids and Surfaces. B, Biointerfaces Feb 2019Candida species, including C. albicans, are part of the mucosal flora of most healthy women, and inhabit the gastrointestinal and genitourinary tracts. Under favourable... (Review)
Review
Candida species, including C. albicans, are part of the mucosal flora of most healthy women, and inhabit the gastrointestinal and genitourinary tracts. Under favourable conditions, they can colonize the vulvovaginal mucosa, giving rise to symptomatic vulvovaginal candidiasis (VVC). The mechanism by which Candida spp. produces inflammation is unknown. Both, the blastoconidia and the pseudohyphae are capable of destroying the vaginal epithelium by direct invasion. Although the symptoms are not always related to the fungal burden, in general, VVC is associated with a greater number of yeasts and pseudohyphae. Some years ago, C. albicans was the species most frequently involved in the different forms of VVC. However, infections by different species have emerged during the last two decades producing an increase in causative species of VVC such as C. glabrata, C. parapsilosis, C. krusei and C. tropicalis. Candida species are pathogenic organisms that have two forms of development: planktonic and biofilm. A biofilm is defined as a community of microorganisms attached to a surface and encompassed by an extracellular matrix. This form of presentation gives microorganisms greater resistance to antifungal agents. This review, about Candia spp. with a special emphasis on Candida albicans discusses specific areas such as biofilm structure and development, cell morphology and biofilm formation, biofilm-associated gene expression, the cell surface and adherence, the extracellular matrix, biofilm metabolism, and biofilm drug resistance in vulvovaginitis biofilms as an important virulence factor in fungi.
Topics: Antifungal Agents; Biofilms; Candida; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Female; Humans
PubMed: 30447520
DOI: 10.1016/j.colsurfb.2018.11.011 -
The Journal of Obstetrics and... Jul 2022To provide an overview of clinical, immunological, and mycological aspects of vulvovaginal candidiasis (VVC). (Review)
Review
AIM
To provide an overview of clinical, immunological, and mycological aspects of vulvovaginal candidiasis (VVC).
METHODS
A literature search was conducted to find relevant articles about different aspects of VVC. Related data from retrieved articles were summarized in different headings.
RESULTS
VVC has a global distribution and Candida albicans is the leading cause of infection except for specific patient groups like postmenopausal, diabetic, or immunocompromised women. VVC has a range of clinical presentations, accordingly, its diagnosis should be based on clinical examination coupled with laboratory investigations. The best therapeutic regimen depends on the patient's conditions and the causative agent. Moreover, factors like drug resistance of the causative agents and different mutations in the immunity-related genes could affect the treatment outcome.
CONCLUSION
As a globally distributed disease, VVC needs further attention, especially in areas related to the treatment failure and recurrence of the disease.
Topics: Antifungal Agents; Candida albicans; Candidiasis, Vulvovaginal; Female; Humans; Treatment Outcome
PubMed: 35445492
DOI: 10.1111/jog.15267 -
The Nurse Practitioner Sep 2023Vaginitis symptoms are among the most common reasons for patients to seek acute gynecological care. NPs who care for women and other patients with vaginas need to be... (Review)
Review
Vaginitis symptoms are among the most common reasons for patients to seek acute gynecological care. NPs who care for women and other patients with vaginas need to be up-to-date on diagnosis and treatment of vulvovaginal candidiasis (VVC) and recurrent VVC (RVVC). Two new antifungal medications for VVC are available. This article reviews vaginal physiology and provides an overview of VVC and RVVC pathophysiology, diagnosis, and treatment options.
Topics: Humans; Female; Fluconazole; Candidiasis, Vulvovaginal; Vagina; Critical Care
PubMed: 37643144
DOI: 10.1097/01.NPR.0000000000000095 -
Obstetrics and Gynecology Clinics of... Dec 2003VVC represents a spectrum of disease. Although there is a clear need for better use of diagnostic modalities and development of better treatment alternatives, most... (Review)
Review
VVC represents a spectrum of disease. Although there is a clear need for better use of diagnostic modalities and development of better treatment alternatives, most patients with VVC, even the complicated cases, at least have the perspective of achieving adequate control of their symptoms. Future advances, particularly in the area of home diagnostics, may help to optimize use of currently available medicines.
Topics: Anti-Bacterial Agents; Antifungal Agents; Candidiasis, Vulvovaginal; Diabetes Complications; Diagnosis, Differential; Estrogens; Female; Humans; Immunosuppression Therapy; Recurrence; Sexual Behavior
PubMed: 14719844
DOI: 10.1016/s0889-8545(03)00083-4 -
Pharmaceutical Research Feb 2023Vulvovaginal candidiasis (VVC) is an opportunistic and endogenous infection caused by a fungus of the Candida genus, which can cause pruritus, dysuria, vulvar edema,... (Review)
Review
Vulvovaginal candidiasis (VVC) is an opportunistic and endogenous infection caused by a fungus of the Candida genus, which can cause pruritus, dysuria, vulvar edema, fissures and maceration of the vulva. The treatment of vaginal candidiasis is carried out mainly by antifungal agents of azole and polyene classes; however, fungal resistance cases have been often observed. For this reason, new therapeutic agents such as essential oils, probiotics and antimicrobial peptides are being investigated, which can be combined with conventional drugs. Local administration of antimicrobials has also been considered to allow greater control of drug delivery and reduce or avoid undesirable systemic adverse effects. Conventional dosage forms such as creams and ointments result in reduced residence time in the mucosa and non-sustained and variable drug delivery. Therefore, advanced solid formulations such as intravaginal rings, vaginal films, sponges and nanofibers have been purposed. In these systems, polymers in different ratios are combined aiming to achieve a specific drug release profile and high mucoadhesion. Overall, a more porous matrix structure leads to a higher rate of drug release and mucoadhesion. The advantages, limitations and technological aspects of each dosage form are discussed in detail in this review.
Topics: Female; Humans; Candidiasis, Vulvovaginal; Antifungal Agents; Candida; Drug Delivery Systems; Drug Compounding; Candida albicans
PubMed: 36451068
DOI: 10.1007/s11095-022-03441-5 -
American Journal of Obstetrics and... Dec 2022Recurrent vulvovaginal candidiasis affects nearly 138 million women globally each year. In the United States, fluconazole is considered the standard of care for acute... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Recurrent vulvovaginal candidiasis affects nearly 138 million women globally each year. In the United States, fluconazole is considered the standard of care for acute vulvovaginal candidiasis, but until recently there was no US Food and Drug Administration-approved drug for the treatment of recurrent vulvovaginal candidiasis. Oteseconazole is a novel oral selective inhibitor of fungal lanosterol demethylase (sterol 14α-demethylase cytochrome P450, an enzyme required for fungal growth) approved for the treatment of recurrent vulvovaginal candidiasis.
OBJECTIVE
This study was conducted to evaluate the efficacy and safety of oral oteseconazole (VT-1161) in the prevention of recurrent culture-verified acute vulvovaginal candidiasis episodes through 50 weeks in participants with recurrent vulvovaginal candidiasis and to compare the efficacy of oteseconazole and fluconazole in the treatment of the presenting acute vulvovaginal candidiasis episode.
STUDY DESIGN
Women and postmenarcheal girls aged ≥12 years with a history of recurrent vulvovaginal candidiasis (N=219) were enrolled at 38 US sites. Eligible participants presenting with an active vulvovaginal candidiasis infection entered an induction phase in which they were randomly assigned 2:1 to receive 600 mg oral oteseconazole on day 1 and 450 mg on day 2, with matching placebo capsules, or to 3 sequential 150-mg oral doses (once every 72 hours) of fluconazole, with matching placebo capsules. Following the 2-week induction phase, the 185 participants with resolved acute vulvovaginal candidiasis infection (a clinical signs and symptoms score of <3) entered the maintenance phase and received 150 mg of oteseconazole or placebo weekly for 11 weeks. Participants were observed for an additional 37 weeks.
RESULTS
In the induction phase, oteseconazole was noninferior to fluconazole in the proportion of participants in the intent-to-treat population with resolved acute vulvovaginal candidiasis infection at the week 2 (day 14) test-of-cure visit, with 93.2% of participants on oteseconazole vs 95.8% on fluconazole achieving resolution. In the maintenance phase, oteseconazole was superior to placebo in the proportion of participants in the intent-to-treat population with ≥1 culture-verified acute vulvovaginal candidiasis episode through 50 weeks, 5.1% compared with 42.2%, respectively (P<.001). Overall, treatment-emergent adverse event rates were similar in both groups: 54% for participants who received oteseconazole in the induction and maintenance phases vs 64% for participants who received fluconazole in the induction phase and placebo in the maintenance phase. Most treatment-emergent adverse events in each group were mild or moderate, with 3.4% of treatment-emergent adverse events graded as severe or higher in the OTESECONAZOLE/oteseconazole group vs 4.2% in FLUCONAZOLE/placebo group.
CONCLUSION
In participants with recurrent vulvovaginal candidiasis, oteseconazole was safe and efficacious in the treatment and prevention of recurrent acute vulvovaginal candidiasis episodes and was noninferior to vulvovaginal candidiasis standard-of-care fluconazole in the treatment of the presenting acute vulvovaginal candidiasis infection.
Topics: Female; Humans; Candidiasis, Vulvovaginal; Fluconazole; Administration, Oral; Antifungal Agents; Infections
PubMed: 35863457
DOI: 10.1016/j.ajog.2022.07.023 -
Australian Family Physician Mar 2005Recurrent vulvovaginal candidiasis affects up to 5% of premenopausal women. It is often associated with significant morbidity and may be difficult to manage. (Review)
Review
BACKGROUND
Recurrent vulvovaginal candidiasis affects up to 5% of premenopausal women. It is often associated with significant morbidity and may be difficult to manage.
OBJECTIVE
This article discusses the pathogenesis investigations and management of recurrent vulvovaginal candidiasis.
DISCUSSION
Recurrent vulvovaginal candidiasis may be misdiagnosed as presenting signs and symptoms are not specific. Examination and microbial testing are required to confirm the diagnosis. Some women appear to have an abnormal host response to the presence of candida species in the vagina, making them susceptible to recurrent episodes of symptomatic infection. Women with recurrent vulvovaginal candidiasis generally respond to a course of suppressive treatment, but many relapse after ceasing therapy.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Drug Resistance, Fungal; Family Practice; Female; Humans; Practice Guidelines as Topic; Recurrence
PubMed: 15799663
DOI: No ID Found -
BMC Women's Health Mar 2019Vulvovaginal candidiasis (VVC) is a common infection affecting women worldwide. Reports of patterns/risk factors/trends for episodic/recurrent VVC (RVVC) are largely...
BACKGROUND
Vulvovaginal candidiasis (VVC) is a common infection affecting women worldwide. Reports of patterns/risk factors/trends for episodic/recurrent VVC (RVVC) are largely outdated. The purpose of this study was to obtain current patient perspectives of several aspects of VVC/RVVC.
METHODS
Business cards containing on-line survey information were distributed to healthy volunteers and patients seeking standard, elective, or referral gynecologic care in university-affiliated Obstetrics/Gynecology clinics. The internet-based questionnaire was completed by 284 non-pregnant women (78% Caucasian, 14% African American, 8% Asian).
RESULTS
The majority of the participants (78%) indicated a history of VVC with 34% defined as having RVVC. The most common signs/symptoms experienced were itching, burning and redness with similar ranking of symptoms among VVC and RVVC patients. Among risk factors, antibiotic use ranked highest followed by intercourse, humid weather and use of feminine hygiene products. A high number of respondents noted 'no known cause' (idiopathic episodes) that was surprisingly similar among women with a history of either VVC or RVVC. VVC/RVVC episodes reported were primarily physician-diagnosed (73%) with the remainder mostly reporting self-diagnosis and treating with over-the-counter (OTC) medications. Most physician-diagnosed attacks utilized a combination of pelvic examination and laboratory tests followed by prescribed antifungals. Physician-treated cases achieved a higher level of symptom relief (84%) compared to those who self-medicated (57%). The majority of women with RVVC (71%) required continual or long-term antifungal medication as maintenance therapy to control symptoms.
CONCLUSIONS
Current patient perspectives closely reflect historically documented estimates of VVC/RVVC prevalence and trends regarding symptomatology, disease management and post-treatment outcomes.
Topics: Adult; Antifungal Agents; Candidiasis, Vulvovaginal; Cross-Sectional Studies; Female; Health Status; Humans; Incidence; Middle Aged; Quality of Life; Risk Factors; Surveys and Questionnaires; Treatment Outcome; Young Adult
PubMed: 30925872
DOI: 10.1186/s12905-019-0748-8 -
Missouri Medicine 2006Recurrent vulvovaginal candidiasis affects five percent of women of child-bearing age. The most common organism is Candidia albicans, but an increasing number of... (Review)
Review
Recurrent vulvovaginal candidiasis affects five percent of women of child-bearing age. The most common organism is Candidia albicans, but an increasing number of infections are caused by nonalbicans species. Fungal culture directs treatment as nonalbicans species may be azole resistant. C. albicans will respond to anyazole antifungal. Treat C. glabrata with boric acid. Maintenance therapy should be started immediately after treatment of the acute episode and should last for six months.
Topics: Acute Disease; Antifungal Agents; Boric Acids; Candida albicans; Candida glabrata; Candidiasis, Vulvovaginal; Episode of Care; Female; Humans; Ketoconazole; Secondary Prevention
PubMed: 16703718
DOI: No ID Found -
American Family Physician Feb 2001Frequently ignored by the medical community, chronic vulvovaginal symptoms are relatively common and can frustrating for patients and physicians. Establishing a proper... (Review)
Review
Frequently ignored by the medical community, chronic vulvovaginal symptoms are relatively common and can frustrating for patients and physicians. Establishing a proper diagnosis will lay the foundation for an effective therapeutic therapeutic plan. Fungal cultures are an important component of the work-up. The most common causes of chronic vaginal symptoms are recurrent vulvovaginal candidiasis (RVVC), vulvar vestibulitis syndrome and irritant dermatitis. In patients with RVVC caused by Candida albicans, host factors may play an important role. Long-term oral antifungal therapy will break the pattern of recurrence in many patients. Infections caused by other species of yeast may be more resistant to standard treatment approaches.
Topics: Candidiasis, Vulvovaginal; Chronic Disease; Diagnosis, Differential; Female; Humans; Hydrogen-Ion Concentration; Recurrence
PubMed: 11237084
DOI: No ID Found