The future of non-invasive azole antifungal treatment options for the management of vulvovaginal candidiasis

Introduction High worldwide prevalence and significant morbidity of vulvovaginal candidiasis (VVC) requires better therapeutic approaches to improve the quality of life of affected women. Although treatment of sporadic acute episodes is often straightforward, complicated and recurrent vulvovaginal candidiasis (RVVC) present medical challenges.Area covered This review focuses on the therapeutic possibilities of VVC with particular interest in the role played by topical antifungal drugs, especially imidazoles, compared to systemic oral treatment with fluconazole, itraconazole, ibrexafungerp or oteseconazole. Infections caused by non-Candida albicans, VVC in pregnant women and RVVC are complex challenges for the physician. Current treatment, therapeutic alternatives and the present and future roles played by noninvasive topical azoles in the therapy of these VVC are highlighted.Expert opinion VVC requires personalized treatment considering whether the woman is pregnant or not, concomitant treatments, the clinical presentation (acute or recurrent) of the infection and the Candida species involved. Although therapeutic tools are increasing, it is important to consider the usefulness of topical drugs, such as clotrimazole and miconazole, which is very relevant in many of these clinical situations. In addition, we must consider that it is also necessary to expand the therapeutic tools with new antifungal agents and formulations, and repurposing current drugs that target these fluconazole-resistant species of Candida.