Recurrent Vulvovaginal Infections: Etiology, Management Strategies, and Challenges in Prevention

Recurrent vulvovaginal infections, including bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and Chlamydia trachomatis infections, are common yet persistent health issues affecting many women. Characterized by symptoms such as itching, discharge, and discomfort, these infections can significantly impair quality of life. Understanding their causes, management, and recurrence factors is essential for effective treatment. BV is primarily caused by a dysbiosis of vaginal flora and biofilm formation, with Gardnerella vaginalis commonly implicated in recurrences. Incomplete treatment, biofilm resistance, and antimicrobial resistance are key factors. Extended regimens with metronidazole or boric acid are options for recurrent BV management. For VVC, Candida albicans and nonalbicans species contribute to recurrences, often requiring extended antifungal regimens. In recurrent vulvovaginal candidiasis, genetic and immunological factors also play roles. Management includes induction and maintenance treatments with fluconazole or topical antifungals, especially in pregnancy. In C. trachomatis infections, treatment focuses on symptom relief, preventing complications, and minimizing reinfection risks, with doxycycline or azithromycin as first-line options. Reinfection from untreated partners is a common recurrence cause. Partner therapy and follow-up testing are crucial across all infections to ensure complete resolution and prevent recurrences. A literature search was conducted in PubMed to identify articles addressing recurrent vulvovaginal infections.