Vulvovaginal Candidiasis: What Are the Promising New Insights in Treatment?

Vulvovaginal Candidiasis: What Are the Promising New Insights in Treatment?V ulvovaginitis, an inflammation of the vulva and vagina, commonly occurs in women of reproductive age and has various causes.Candidal vulvovaginitis is caused by inflammation of the vulvar and vaginal epithelium due to infection by Candida species, with Candida albicans, a polymorphic opportunistic fungus, being the most common.Candidal vulvovaginitis accounts for approximately one-third of all vulvovaginitis cases.Common clinical features include thick-whiteadherent discharge, swelling, vulvovaginal erythema, and excoriations.The condition is primarily diagnosed through clinical examination and tests such as vaginal wet prep, pH testing, and cultures to rule out other causes of vulvovaginal infection, including bacterial vaginosis, gonorrhea, and chlamydia (1).Acute vulvovaginal candidiasis is managed with antifungal medications.Antifungals can be administered in various ways, such as a single oral dose of fluconazole or intravaginal application of terconazole.Considering the susceptibility of antifungals used in the treatment of vulvovaginal candidiasis, recent findings indicate that Candida species exhibit the highest susceptibility to Amphotericin B, followed by ketoconazole, miconazole, voriconazole, and fluconazole (2).Extended treatment regimens are generally preferred in treating patients with complicated vulvovaginal candidiasis, including those with recurrent infections or immunosuppressed ones.This may include intravaginal azole therapy for at least seven days or oral fluconazole administered once every three days for three doses.Patients with recurrent vulvovaginal candidiasis might receive benefits from suppressive therapy, like weekly oral fluconazole therapy, for six months.However, oral antifungals are not suggested to be prescribed during pregnancy.Some authors still recommend a one-week course of intravaginal treatment for pregnant women (3).An analysis was launched to explore alternative methods using herbs such as berberine, dill, and turmeric in response to the rising number of resistant strains and the increased recurrence of vulvovaginal candidiasis with conventional