Management of recurrent vulvovaginal candidosis: Narrative review of the literature and European expert panel opinion Original paper

What was reviewed?

This review evaluated the current management strategies for recurrent vulvovaginal candidiasis (RVVC), summarizing clinical guidelines, real-world clinical practices, therapeutic challenges, and expert opinions from a panel of European specialists. It specifically reviewed the effectiveness and limitations of existing antifungal therapies, diagnostic approaches, pathogen characteristics, and future therapeutic options.

Who was reviewed?

The review analyzed the collective expertise of a panel of 10 European gynecology specialists from countries including Belgium, Finland, France, Germany, Hungary, Italy, Poland, Romania, Spain, and the UK. These experts discussed RVVC management through structured online sessions, covering diagnosis, treatment regimens, patient experiences, and novel therapies. Their insights were compared against published scientific evidence and current clinical guidelines.

What were the most important findings?

The review identifies recurrent vulvovaginal candidiasis (RVVC) as primarily caused by Candida albicans, although infections by non-albicans species, particularly Candida glabrata, are increasingly common. Resistance to standard antifungal treatments like fluconazole, though still uncommon, is gradually rising due to repeated and prolonged exposure to antifungal medications. Fluconazole remains the recommended first-line treatment for acute episodes and maintenance therapy, yet a significant proportion of women experience recurrence after discontinuing maintenance treatment, highlighting the necessity for improved long-term therapeutic options.

The complexity of RVVC is underscored by its intricate microbiological environment, where interactions between Candida species, the host immune system, and vaginal microbiota play critical roles. Neutrophil dysfunction, genetic susceptibility, and diminished populations of protective Lactobacillus species in the vaginal microbiome significantly contribute to disease recurrence and severity. Diagnostic approaches relying on microscopy and culture are crucial but inconsistently implemented, often compromised by prior patient self-treatment. The review emphasizes promising future therapies, such as the selective antifungal oteseconazole and the novel glucan synthase inhibitor ibrexafungerp, alongside emerging immunotherapeutic vaccines targeting critical fungal proteins, which offer significant potential to improve patient outcomes.

What are the greatest implications of this review?

The review underscores the urgent need for optimized diagnostic and treatment strategies for RVVC. It suggests that clinicians should carefully consider personalized regimens due to the significant recurrence rates and variability in patient response. New therapeutic agents, especially those targeting resistant strains and immune pathways, hold significant promise and should be a focus of future research. Moreover, enhancing clinician and patient awareness about RVVC’s substantial impact on quality of life is vital for better patient care and adherence.