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Expert Review of Anti-infective Therapy 2023Recurrent vulvovaginal candidiasis (RVVC) affects women worldwide and has far-reaching implications for a patient's quality of life. For decades, maintenance treatment... (Review)
Review
INTRODUCTION
Recurrent vulvovaginal candidiasis (RVVC) affects women worldwide and has far-reaching implications for a patient's quality of life. For decades, maintenance treatment using the azole antifungal fluconazole was the preferred treatment. Although efficient in controlling the symptoms, the development of azole resistance and high rates of recurrence after therapy cessation have emerged as significant limitations. Nevertheless, persistent efforts have delivered novel treatment options. Oteseconazole (VT-1161), marketed as VIVJOA, is an oral, tetrazole antifungal with unprecedented specificity toward the fungal lanosterol 14α-demethylase.
AREAS COVERED
We reviewed literature data on oteseconazole with a focus on the management of RVVC.
EXPERT OPINION
Therapeutic options for RVVC are limited, and novel, innovative approaches are needed to treat this debilitating condition. These therapies need to be well-tolerated and prevent RVVC recurrence. The available clinical data show excellent safety and efficacy, with an unprecedentedly low recurrence rate. However, we believe health-care providers should be mindful to monitor for the development of resistance, as this may result in treatment failure. Further, the availability and cost may, like for most novel drugs, affect the widespread clinical implementation of VIVJOA. Altogether, we are convinced that VIVJOA is a significant advance in RVVC management.
Topics: Female; Humans; Antifungal Agents; Candidiasis, Vulvovaginal; Quality of Life; Drug Resistance, Fungal; Fluconazole; Azoles; Recurrence
PubMed: 37449774
DOI: 10.1080/14787210.2023.2233696 -
Journal of Medical Microbiology May 2023Recurrent vulvovaginal candidiasis (RVVC) is a microbial, immune and sexual health disorder impacting up to 10 % of the adult female population. Fluconazole is a... (Review)
Review
Recurrent vulvovaginal candidiasis (RVVC) is a microbial, immune and sexual health disorder impacting up to 10 % of the adult female population. Fluconazole is a well-established antifungal drug commonly utilized for acute and long-term RVVC treatment. This insight review provides an overview of known vaginal and gastrointestinal microbiota characteristics in RVVC, presents the potential impacts of fluconazole therapy on multi-microbiome relationships and discusses implications for future research and clinical practice. Next-generation sequencing (NGS) and molecular methods to accurately define vaginal microbiota trends in RVVC are not comprehensively available, limiting understanding of microbiota roles in RVVC. Inconsistencies and variances in profiles in RVVC women suggest poorly understood disease implications on the bacterial and fungal microbiomes. Investigations of environmental conditions like vaginal pH, drug therapy's impact, especially fluconazole maintenance therapy, and the elucidation of multi-microbiome relationships in RVVC are required to further investigate disease pathogenesis and responsible antimicrobial prescribing.
Topics: Adult; Female; Humans; Antifungal Agents; Fluconazole; Candidiasis, Vulvovaginal; Candida albicans; Microbiota; Recurrence
PubMed: 37171871
DOI: 10.1099/jmm.0.001705 -
The Medical Letter on Drugs and... Aug 2022
Topics: Administration, Oral; Antifungal Agents; Candidiasis, Vulvovaginal; Female; Humans
PubMed: 35921077
DOI: No ID Found -
The Australasian Journal of Dermatology Nov 2012Vulvovaginal candidiasis (VVC) is defined as vulvovaginitis, causally associated with Candida species in the vagina. It is seen commonly in vulval clinics as a cause of... (Review)
Review
Vulvovaginal candidiasis (VVC) is defined as vulvovaginitis, causally associated with Candida species in the vagina. It is seen commonly in vulval clinics as a cause of persistent vulvovaginitis and yet this chronic condition is yet to be formally defined and explained. The classic symptom complex of chronic itch, pain and dyspareunia exacerbating premenstrually and remitting during menstruation associated with an erythematous vulval eruption is well described but the exact aetiology remains elusive. Research in recent years has suggested that VVC is not an opportunistic infection or an immunodeficiency but a hypersensitivity response to a commensal organism that may be genetically determined. Further, it is apparent on clinical grounds that oestrogen plays an essential permissive role and that, in healthy non-diabetic patients, VVC does not occur in the absence of oestrogen whether endogenous or exogenous. The nature of this relationship has not been established. In this article I discuss the diagnostic features of VVC, its management and what is currently understood of its aetiology.
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Chronic Disease; Estrogens; Female; Humans
PubMed: 22998230
DOI: 10.1111/j.1440-0960.2011.00860.x -
Journal de Mycologie Medicale Nov 2022Vaginal infections are one of the most common reason for gynecological consultations. Many of them are the result of overgrowth of resident microorganisms. The clinical...
INTRODUCTION
Vaginal infections are one of the most common reason for gynecological consultations. Many of them are the result of overgrowth of resident microorganisms. The clinical symptoms of vulvovaginal candidiasis are nonspecific and an accurate diagnosis is a problem that often leads to inadequate treatment or delays in treatment. The lack of an exact and practical diagnostic method is a common cause of misdiagnosis.
AIM
To create a complex, quantitative method for the diagnosis of vulvovaginal candidiasis which to enables differentiation from vaginal fungal colonization.
MATERIAL AND METHODS
A total of 2306 vaginal samples were examined. Clinical, microbiological, epidemiological methods and statistical models are used.
RESULTS AND DISCUSSION
The proposed score system is a specific, sensitive and inexpensive method to routinely diagnose vulvovaginal candidiasis. Statistical processing of the obtained data shows the impact of the individual components on which the method is based: the presence of vaginal discharge, pruritus, direct microscopy and assessment of the fungal growth. The data analysis reveals good sensitivity (71%) and high specificity (98%) of the method. This allows accurate interpretation of the result of the clinical and microbiological examination of each patient.
CONCLUSION
The system for diagnosing vulvovaginal candidiasis is complex and based on quantitative indicators. The method can be used to differentiate vulvovaginal candidiasis from vaginal fungal colonization (the cut-off value is 5.5 points) and to more accurately interpret a Candida positive result from quantitative real-time PCR in asymptomatic patients or in women with mixed vaginal infection.
Topics: Humans; Female; Candidiasis, Vulvovaginal; Candida; Vagina
PubMed: 35717682
DOI: 10.1016/j.mycmed.2022.101302 -
Clinical Evidence Dec 2003
Review
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Fluconazole; Humans; Imidazoles; Itraconazole; Ketoconazole; Male; Nystatin; Secondary Prevention; Sexual Partners
PubMed: 15555192
DOI: No ID Found -
Clinical Evidence Dec 2004
Review
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Fluconazole; Humans; Itraconazole; Nystatin; Secondary Prevention
PubMed: 15865803
DOI: No ID Found -
Clinical Evidence Dec 2005
Review
Topics: Antifungal Agents; Candidiasis, Vulvovaginal; Female; Fluconazole; Humans; Itraconazole; Ketoconazole; Nystatin; Secondary Prevention
PubMed: 16620487
DOI: No ID Found -
The Journal of Obstetrics and... Dec 2022Vulvovaginal candidiasis (VVC), is a common fungal infection that remains a global concern. The objectives of this study were molecular identification and assessment of...
AIM
Vulvovaginal candidiasis (VVC), is a common fungal infection that remains a global concern. The objectives of this study were molecular identification and assessment of the antifungal susceptibility profile of Candida species, causing VVC in southeast Iran.
METHODS
A cross-sectional investigation was carried out on 119 nonpregnant females suspected of VVC between February 2019 and May 2021. Yeast samples were characterized to the species level by conventional and molecular methods. All Candida isolates were examined for in vitro susceptibility profile to six conventional antifungal drugs using Clinical and Laboratory Standards Institute guidelines.
RESULTS
Out of 119 subjects, 52 (43.7%) cases were affected by VVC, out of whom 11 (21.15%) cases had recurrent vulvovaginal candidiasis (RVVC). The species distribution was as follows; Candida albicans (n = 21; 40.4%), C. glabrata (n = 11; 21.2%), C. tropicalis (n = 9; 17.3%), C. parapsilosis (n = 5; 9.7%), C. africana (n = 3; 5.7%), C. famata (n = 1; 1.9%), C. lusitaniae (n = 1; 1.9%), and C. dubliniensis (n = 1; 1.9%). The resistance rate of Candida isolates to fluconazole, itraconazole, and voriconazole were 15.38%, 11.5%, and 3.8%, respectively. Resistance to fluconazole was obtained in 46% (5/11) of RVVC cases but only in 7% (3/41) of VVC cases.
CONCLUSION
This study demonstrated that the majority of VVC cases were caused by non-albicans Candida species which also were resistant to some antifungal agents. Hence, our findings revealed the importance of conducting periodical epidemiological studies to determine changes in species distribution. Moreover, for effective management of treatment and infection, it is imperative to evaluate the susceptibility profiles of Candida species isolated from VVC patients.
Topics: Humans; Female; Candidiasis, Vulvovaginal; Antifungal Agents; Iran; Fluconazole; Cross-Sectional Studies; Drug Resistance, Fungal; Microbial Sensitivity Tests; Candida albicans
PubMed: 36184563
DOI: 10.1111/jog.15442 -
Nature Reviews. Urology Nov 2021
Topics: Candidiasis, Vulvovaginal; Glycosides; Humans; Triterpenes
PubMed: 34548655
DOI: 10.1038/s41585-021-00522-9