Treatment of Vulvovaginal Candidiasis-An Overview of Guidelines and the Latest Treatment Methods

Abstract

Vulvovaginal candidiasis (VVC) is a common condition associated with discomfort in affected women. Due to the presence of different forms of the disease, diverse treatment regimens are developed; the newest ones include oteseconazole and ibrexafungerp. Here, we focus on the most up-to-date recommendations regarding VVC treatment, as well as novel treatment options. Topical and oral azoles are the drugs of choice in uncomplicated mycosis. The efficacy of probiotics and substances such as TOL-463 and chlorhexidine is indicated as satisfactory; however, there are no relevant guidelines. Although the majority of researchers agree that the treatment of non-albicans VVC should be long-lasting, the recommendations are inconsistent. Another clinical problem is the treatment of VVC with azole intolerance or resistance, for which literature proposes the use of several drugs including oteseconazole, ibrexafungerp, and voriconazole. The treatment schedules for recurrent VVC include mainly fluconazole; however, alternative options such as immunotherapeutic vaccine (NDV-3A) or designed antimicrobial peptides (dAMPs) were also described. We also focused on VVC affecting pregnant women, which is a substantial challenge in clinical practice, also due to the heterogeneous relevant guidelines. Thus far, few precise recommendations are available in the literature. Future studies should focus on atypical VVC forms to elucidate the inconsistent findings.

Keywords: azoles; ibrexafungerp; immunotherapy; oteseconazole; recurrent vulvovaginal candidiasis; vagina; vulvovaginal candidiasis.

Figure 1

Oteseconazole—mechanism of action [53]. Oteseconazole, similar to triazoles, inhibits the fungal lanosterol 14α-demethylase and, as a result, inhibits ergosterol biosynthesis. Nevertheless, in contrast to triazoles, oteseconazole has not three, but four nitrogen atoms in a five-member ring. This results in greater selectivity for fungal enzymes [53].

Figure 2

Ibrexafungerp—mechanism of action [53]. Ibrexafungerp inhibits the production of 1,3-β-d-glucan through non-competitive inhibition of the 1,3-β-d-glucan synthase complex. It results in cell instability and eventual lysis. The mechanism of action is similar to that of echinocandins; nevertheless, they are structurally different [53].