Recurrent vulvovaginal candidiasis

Abstract

Vulvovaginal candidiasis occurs frequently in women. In recent studies they have estimated that 75% of women will present at least one episode in their lifetime, with most of the cases accruing during the women’s reproductive age. Vulvovaginal candidiasis is not a sexually transmitted disease/infection however, a differential diagnosis should always be made with other pathologies which are sexually transmitted, such as bacterial vaginosis and trichomoniasis.

To make a correct diagnosis, it is important to rely on clinical findings during the physical exam, but it is also important to use other tools such as: direct fresh examination, gram stain or vaginal discharge culture. Of the clinical findings, the most common are vulvar pruritus, erythema and vaginal irritation may also occur, characteristic vaginal discharge which is generally described as an odorless whitish lumpy discharge, dysuria and even dyspareunia. After conducting the physical exam, it is important to confirm with microbiological analysis, which allows an accurate diagnosis. In some cases, it is possible to identify the specific causative microorganism and its respective sensitivity towards antifungal agents, which allows to reduce the resistance that is caused by inappropriate use of these medications.

The recurrence of this infection is defined as the at least four episodes in a year, which causes great discomfort in many women. Unfortunately, there are no treatments that would completely eradicate recurrences. There are suppressive therapies like the administration of fluconazole on weekly basis for six months which greatly helps prevent infections during this period, but it is not a curative treatment. With the cessation of the treatments, the episodes can occur again, which causes a direct impact on women’s quality of life since it affects health in all its aspects: physical, mental, and social because of that it’s important to have a clear diagnosis and adequate treatment approach.