A new article published in Mycoses discussed that vulvovaginal candidosis (VVC) is a common presentation and occurs in about 70-75% of women. In premenopausal, pregnant, asymptomatic and healthy women and women with acute VVC, Candida albicans is the predominant species.

The authors stated that the diagnosis of VVC should be based on clinical symptoms and microscopic detection of pseudohyphae. Clinical findings may not differentiate the causes of vaginitis in most cases. In recurrent or complicated cases, diagnostics should involve fungal culture with species identification. However, serological determination of antibody titres has no role in VVC. 

This article further stated that before the induction of therapy, VVC should always be medically confirmed. Acute VVC can be treated with local imidazoles – polyenes or ciclopirox olamine—as vaginal tablets, ovules or creams. While triazoles can be prescribed orally, along with antifungal creams, for the treatment of the vulva. Commonly available antimycotics are generally well tolerated, and the different regimens show similarly good results. Antiseptics are potentially effective but act against the physiological vaginal flora. 

On the other hand, asymptomatic patients should not be treated. Women with chronic recurrent Candida albicans vulvovaginitis should undergo dose-reducing maintenance therapy. Meanwhile, non-albicans vaginitis should be treated with alternative antifungal agents. In the last 6 weeks of pregnancy, antifungal treatment is indicated to reduce the risk of vertical transmission, oral thrush and diaper dermatitis of the newborn. Local treatment is preferred through pregnancy.

Source: Mycoses. 2021 Jun;64(6):583-602. doi: 10.1111/myc.13248.