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Review
. 2022 Sep 9:12:934353.
doi: 10.3389/fcimb.2022.934353. eCollection 2022.

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

Gilbert Donders  1   2   3 , István Oszkár Sziller  4 , Jorma Paavonen  5 , Phillip Hay  6 , Francesco de Seta  7 , Jean Marc Bohbot  8 , Jan Kotarski  9 , Jordi Antoni Vives  10 , Bela Szabo  11 , Ramona Cepuliené  12 , Werner Mendling  13
Affiliations
Review

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

Gilbert Donders et al. Front Cell Infect Microbiol. .

Abstract

Recurrent vulvovaginal candidosis (RVVC) is a chronic, difficult to treat vaginal infection, caused by Candida species, which affects women of all ages and ethnic and social background. A long-term prophylactic maintenance regimen with antifungals is often necessary. In most clinical practice guidelines, oral fluconazole is recommended as the first-line treatment. Although clinical resistance to antifungal agents remains rare, overexposure to azoles may increase the development of fluconazole-resistant C. albicans strains. In addition, non-albicans Candida species are frequently dose-dependent susceptible or resistant to fluconazole and other azoles, and their prevalence is rising. Available therapeutic options to treat such fluconazole-resistant C. albicans and low susceptibility non-albicans strains are limited. Ten experts from different European countries discussed problematic issues of current RVVC diagnosis and treatment in two audiotaped online sessions and two electronic follow-up rounds. A total of 340 statements were transcribed, summarized, and compared with published evidence. The profile of patients with RVVC, their care pathways, current therapeutic needs, and potential value of novel drugs were addressed. Correct diagnosis, right treatment choice, and patient education to obtain adherence to therapy regimens are crucial for successful RVVC treatment. As therapeutic options are limited, innovative strategies are required. Well- tolerated and effective new drugs with an optimized mechanism of action are desirable and are discussed. Research into the impact of RVVC and treatments on health-related quality of life and sex life is also needed.

Keywords: antifungal; azole therapy; expert opinion; maintenance regimen; recurrent vulvovaginal candidosis; routine clinical practice.

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Conflict of interest statement

GD, IS, JP, PH, FS, JB, JK, JV, BS, and WM are expert consultants to the pharmaceutical industry, including Gedeon Richter. RC is an employee at Gedeon Richter.This study received funding from Gedeon Richter Plc. The funder had the following involvement with the study: design and collection of data, and on the decision to submit the manuscript for publication. Authors led the analysis and interpretation of data, and the writing of the manuscript. All authors declare no other competing interests.

Figures

Figure 1
Figure 1
The patient pathway in the real world.
See this image and copyright information in PMC

References

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