Diagnosis and treatment of vulvovaginal candidiasis: a practical approach

Candida infections are the second most common cause of vaginal infection, after bacterial vaginosis. The large majority of Candida spp. infections are caused by C. albicans (about 85-95%). The remaining part is caused by other pathogens such as C. glabrata, C. parapsilosis, C. krusei and C. tropicalis. Episodic vulvovaginal candidiasis (VVC) includes normal women with mild to moderate symptoms and no history of persistent or recurrent symptoms. Culture-dependent analysis and microscopic examination of vaginal fluid are recommended for episodic VVC diagnosis when the laboratory or clinical facilities are available. The current best test to diagnose Candida in women is microscopy. Complicated VVC may be defined as that which is recurrent (4 or more episodes in 12 months), associated with severe symptoms, the result of a non-albicans species, or present in a compromised host. This condition is more common in those with immunosuppression, diabetes, or both. Additional testing for HIV and diabetes may be warranted in these situations. When there is evidence of complicated VVC, collection of vaginal fluid for culture and yeast speciation may help to identify the therapy because, in such cases, there is an increased likelihood of non-albicans strains. All national and international guidelines include therapeutic options over-the-counter (OTC) or requiring medical prescription. Azoles topical single-use administration represents the therapy of choice of acute vaginal infection by Candida. The treatment with vaginal single dose of clotrimazole or isoconazole or fenticonazole has reported a cure rate of about 95-100% at 7 days and 50-90% at one month. In consideration of the high cure rate and the high REVIEW