Recurrent Candida Vulvovaginitis

Abstract

Vulvovaginal candidiasis (VVC), predominantly caused by Candida albicans, is estimated to affect about 138 million women each year worldwide and 492 million over their lifetimes. Recurrent VVC (RVVC), defined as four or more episodes of VVC in a year, is increasingly recognized and constitutes up to 10% of the cases of VVC. RVVC is an important clinical and global public health challenge project that will affect about 160 million per year by 2030. RVVC significantly affects the quality of life of the affected women. Host factors, such as underlying immunosuppressive conditions and genetic predisposition, are suggested key risk factors for recurrence. However, an increasingly higher prevalence of non-albicans Candida (NAC) species, such as C. glabrata, C. tropicalis, C. krusei, C. parapsilosis, C. dubliniensis, C. guilliermondii, and others, which are either intrinsically resistant to azoles or have higher minimum inhibitory concentrations to most antifungal agents, such as fluconazole, which are commonly used for the treatment of VVC/RVVC, has been reported. Therefore, treatment remains a challenge. Long-term maintenance antifungal is required to avoid recurrence of symptoms. Alternative treatment includes boric acid and topical amphotericin B; however, they are associated with serious side effects, limiting their use. The oral echinocandin ibrexafungerp is well-tolerated and efficacious against Candida vulvovaginitis. RVVC presents a unique area for continued research and development.