Candidiasis of vulva
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Understanding Vulvovaginal Candidiasis (VVC): Prevalence, Risk Factors, and Treatment
Prevalence of Vulvovaginal Candidiasis
Vulvovaginal candidiasis (VVC) is a common infection affecting millions of women globally. In sub-Saharan Africa, the pooled prevalence of VVC is approximately 33%, with pregnant women having a slightly higher risk compared to non-pregnant women 1. The prevalence among pregnant women in Africa is estimated at 29.2%, with regional variations showing higher rates in Eastern Africa 10. Globally, recurrent VVC affects about 138 million women annually, with the highest prevalence in the 25-34 year age group 5.
Etiology and Pathogenesis
VVC is primarily caused by Candida albicans, which accounts for about 71.7% of cases. Non-albicans Candida (NAC) species, such as C. glabrata, C. krusei, and C. tropicalis, also contribute significantly to the infection 1. The pathogenesis of VVC involves an imbalance between Candida colonization and the host environment, often triggered by physiological or non-physiological changes 8. Factors such as pregnancy, diabetes, immunosuppression, and antibiotic use are known to predispose women to VVC 89.
Risk Factors
Several host-related and behavioral factors increase the risk of developing VVC. Host-related factors include pregnancy, hormone replacement therapy, uncontrolled diabetes, and immunosuppression. Behavioral factors include the use of oral contraceptives, intrauterine devices, spermicides, and certain hygiene practices 8. Women with HIV infection are also at higher risk due to lower CD4+ T-cell counts, which are associated with increased rates of VVC 4.
Diagnosis and Treatment
Yeast culture remains the gold standard for diagnosing VVC, although newer molecular assays have shown promising results 4. Azole antifungals are the treatment of choice for uncomplicated VVC. For recurrent VVC, new drugs like oteseconazole and ibrexafungerp are emerging as potential treatments 4. In cases of VVC caused by non-albicans yeast, boric acid has been found to be effective 4.
Relationship with Provoked Vulvodynia
There is an observed overlap in symptoms between VVC and provoked vulvodynia (PVD), a chronic vulvar pain condition. Studies indicate a significantly increased odds ratio for self-reported VVC in PVD cases compared to controls, suggesting a potential link between the two conditions 2. However, due to the heterogeneity of the studies, a definitive relationship remains unclear 2.
Conclusion
Vulvovaginal candidiasis is a prevalent condition with significant implications for women's health. Understanding its etiology, risk factors, and effective treatment options is crucial for improving the quality of care for affected women. Further research is needed to explore the geographical distribution of VVC and to develop more effective diagnostic and therapeutic strategies.
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Most relevant research papers on this topic
Prevalence, Antifungal Susceptibility and Etiology of Vulvovaginal Candidiasis in Sub-Saharan Africa: A Systematic Review with Meta-analysis and Meta-regression.
Vulvovaginal candidiasis (VVC) is prevalent in sub-Saharan Africa, mainly caused by C. albicans, with a higher risk in pregnant women and symptomatic patients.
Meta-AnalysisThe Relationship Between Vulvovaginal Candidiasis and Provoked Vulvodynia: A Systematic Review.
This review cannot definitively link vulvovaginal candidiasis and prompted vulvodynia, as studies were based on self-reported candidiasis.
Systematic ReviewVulvovaginal Candidiasis: A Current Understanding and Burning Questions
Vulvovaginal candidiasis (VVC) is a common, non-lethal infection of the lower female reproductive tract, with current understanding of epidemiology, host response, fungal pathogenicity mechanisms, and microbiome impact.
Highly CitedVulvovaginal Candidiasis: A Review of the Evidence for the 2021 Centers for Disease Control and Prevention of Sexually Transmitted Infections Treatment Guidelines.
The 2021 CDC STI Treatment Guidelines for Vulvovaginal Candidiasis reflect new knowledge and changes in treatment recommendations, with yeast culture as the gold standard for diagnosis and new treatments like TOL-463 and ibrexafungerp for recurrent cases.
Systematic ReviewGlobal burden of recurrent vulvovaginal candidiasis: a systematic review.
Recurrent vulvovaginal candidiasis affects 138 million women annually and 372 million women over their lifetime, with the 25-34 year age group having the highest prevalence (9%).
Systematic ReviewHighly CitedRecurrent vulvovaginal candidiasis.
The probability of recurrent vulvovaginal candidiasis (RVVC) is high, suggesting it is a common condition with varying estimates by country.
Observational StudyHighly CitedVulvovaginal candidiasis: epidemiologic, diagnostic, and therapeutic considerations.
Vulvovaginal candidiasis has a high prevalence in North America, but inadequate epidemiologic data and undefined standards of care hinder its diagnosis and treatment.
Highly CitedVulvovaginal candidiasis: Epidemiology, microbiology and risk factors
Vulvovaginal candidiasis (VVC) is a common infection caused by Candida species, with host-related and behavioral factors playing a significant role in its development and recurrence.
Highly CitedVulvovaginal Candidiasis: Epidemiology and Risk Factors, Pathogenesis, Resistance, and New Therapeutic Options
Vulvovaginal candidiasis affects 75% of women and is influenced by factors such as pregnancy, diabetes, hormonal contraceptives, antibiotics, and steroids, with new drug formulations promising increased antifungal activity.
Prevalence of vulvovaginal candidiasis among pregnant women in Africa: A systematic review and meta-analysis.
Vulvovaginal candidiasis prevalence among African pregnant women is 29.2%, with higher prevalence in Eastern Africa, followed by Western Africa and North Africa, with advanced detection methods and larger sample sizes potentially increasing the prevalence.
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