Management of recurrent vulvovaginal candidosis as a chronic illness

Femicare, Clinical Research for Women, Tienen, Belgium. gilbert.donders @
Gynecologic and Obstetric Investigation (Impact Factor: 1.25). 10/2010; 70(4):306-21. DOI: 10.1159/000314022
Source: PubMed

ABSTRACT For sporadic acute Candida vaginitis, any oral or local antifungal therapy can be used. For women with recurrent vulvo-vaginal candidosis (RVC), on the other hand, such simple approaches are insufficient, regardless of the product chosen. Instead, RVC should be managed as any other chronic disease and requires long-term, prophylactic, suppressive antifungal treatment. A regimen using individualized, decreasing doses of oral fluconazole (the ReCiDiF regimen) was proven to be highly efficient and offered great comfort to the patients. During this regimen, it is crucial that patients are carefully examined by anamnestic, clinical, microscopic and culture-proven absence of Candida. If a relapse occurs, the medication is adjusted and efforts are taken to find a possible triggering factor for the reactivation of the infection. Care has to be taken not to accumulate 'don't do's', unless the efficiency of a measure has been proven, by trying to eliminate one risk factor at a time for 2 months. Known possible triggers to be kept in mind are (1) antibiotic use, (2) use of specific contraceptives, especially combined contraceptive pills, (3) disturbed glucose metabolism, (4) the use of personal hygienic products, and (5) tight clothing or plastic panty liners. In therapy-resistant cases, non-albicans infection must be ruled out, and alternative therapies should be tried. Boric acid is proven to be efficient in most of these resistant cases, but other non-azoles like amphotericin B, flucytosine, gentian violet, and even caspofungin may have to be tried. As a final remark it has to be said that many patients feel poorly understood and inefficiently managed by many care-givers, increasing their feelings of guilt and sexual inferiority. Therefore, attention has to be given to take the disease seriously, follow strict treatment regimens, and advise precisely and based on individual evidence concerning any possible risk factors for recurrence. In case of therapy-resistant vulvo-vaginitis, reconsider your diagnosis and/or consider referral to specialized therapists.

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    • "Despite RVVC being considered a Candida infection that is more dependent on the host characteristics, therapeutics approaches available and able to allow a remission of the symptoms between episodes are antifungal drugs used for a long period of time [8] [9] [11]. Some authors consider that new therapeutic strategies must be considered for RVVC control [3] [9] [10]. In addition to the limited number of available antifungal drugs, the restrictions to its use stress the need for the development and validation of new therapeutic strategies exhibiting distinct mechanisms of action and/or evasion of resistance [12] [13] [14] [15]. "
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